• Ary Serpa Neto, Rodrigo Octavio Deliberato, JohnsonAlistair E WAEWLaboratory for Computational Physiology, Institute for Medical Engineering and Science, MIT, Cambridge, MA, USA., Lieuwe D Bos, Pedro Amorim, Silvio Moreto Pereira, Denise Carnieli Cazati, Ricardo L Cordioli, Thiago Domingos Correa, Tom J Pollard, SchettinoGuilherme P PGPPDepartment of Critical Care Medicine, Hospital Israelita Albert Einstein, Albert Einstein Avenue, 700, São Paulo, Brazil., Karina T Timenetsky, Leo A Celi, Paolo Pelosi, Gama de AbreuMarceloMPulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany., Marcus J Schultz, and PROVE Network Investigators.
• Department of Intensive Care and Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Academic Medical Center, Amsterdam, The Netherlands. aryserpa@terra.com.br.
• Intensive Care Med. 2018 Nov 1; 44 (11): 191419221914-1922.

PurposeMechanical power (MP) may unify variables known to be related to development of ventilator-induced lung injury. The aim of this study is to examine the association between MP and mortality in critically ill patients receiving invasive ventilation for at least 48 h.MethodsThis is an analysis of data stored in the databases of the MIMIC-III and eICU. Critically ill patients receiving invasive ventilation for at least 48 h were included. The exposure of interest was MP. The primary outcome was in-hospital mortality.ResultsData from 8207 patients were analyzed. Median MP during the second 24 h was 21.4 (16.2-28.1) J/min in MIMIC-III and 16.0 (11.7-22.1) J/min in eICU. MP was independently associated with in-hospital mortality [odds ratio per 5 J/min increase (OR) 1.06 (95% confidence interval (CI) 1.01-1.11); p = 0.021 in MIMIC-III, and 1.10 (1.02-1.18); p = 0.010 in eICU]. MP was also associated with ICU mortality, 30-day mortality, and with ventilator-free days, ICU and hospital length of stay. Even at low tidal volume, high MP was associated with in-hospital mortality [OR 1.70 (1.32-2.18); p < 0.001] and other secondary outcomes. Finally, there is a consistent increase in the risk of death with MP higher than 17.0 J/min.ConclusionHigh MP of ventilation is independently associated with higher in-hospital mortality and several other outcomes in ICU patients receiving invasive ventilation for at least 48 h.

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