The Association Between Mechanical Power and Mortality in Critically Ill Patients Receiving Invasive Mechanical Ventilation: A Systematic Review and Meta-Analysis.

Summary

Across 34 studies, non-survivors had higher mechanical power during invasive ventilation, and each 1 J/min increase independently associated with higher mortality. A threshold above roughly 17 J/min identified greater risk, supporting mechanical power as a clinically relevant marker of ergotrauma.

Key Findings

• Mechanical power was significantly higher in nonsurvivors vs survivors (MD 1.91 J/min; 95% CI 1.30–2.51).
• Higher mortality per 1 J/min increase in mechanical power (pooled AOR 1.04; 95% CI 1.03–1.06; pooled AHR 1.03; 95% CI 1.00–1.07).
• Normalized mechanical power (per predicted body weight and per compliance) remained higher in nonsurvivors.
• A threshold above approximately 17 J/min was associated with increased mortality (OR 1.60; 95% CI 1.34–1.91).

Clinical Implications

Consider integrating mechanical power into lung-protective ventilation and target lower values (potentially <17 J/min) while balancing gas exchange. Prospective trials are needed to test whether reducing mechanical power improves outcomes.

Limitations

• Based on observational data; residual confounding cannot be excluded.
• Potential clinical and methodological heterogeneity across studies.

Future Directions

Prospective interventional trials should test whether strategies that lower mechanical power improve survival and other patient-centered outcomes.