Correlations of mechanical power and its components with age and its interference in the outcome of SARS-CoV-2 in subjects undergoing pressure-controlled ventilation

Claudio Luciano Franck, Gustavo Maysonnave Franck, Ehab G. Daoud

Cite

Franck CL, Franck GM, Daoud EG. Correlations of mechanical power and its components with age and its interference in the outcome of SARS-CoV-2 in subjects undergoing pressure-controlled ventilation. J Mech Vent 2022; 3(4):159-168.

Abstract

Introduction

SARS-CoV-2 may be associated with ARDS and the VILI. However, there are still doubts about the correlations and the interference of tidal energy in the outcomes. The objective of this study was to verify the correlations and interference of mechanical power and its components with age in the outcome in SARS-CoV-2 of subjects undergoing pressure-controlled ventilation (PCV).

Method

Longitudinal, prospective, observational, analytical, and quantitative study of the information collected on two parameters of the mechanical ventilator, to calculate the mechanical power by Becher formula in 163 subjects with SARS-CoV-2 and moderate ARDS between May 2021 to September 2021.

Results

Correlations were found between mechanical power and its components, except for compliance (P 0.234), elastance (P 0.515), resistance (P 0.570) and age (P 0.180). There was a significant impact on the outcome in the univariate analysis of age, as well as of mechanical power and its components, except for positive end expiratory pressure (PEEP) (P 0.874), minute ventilation (Ve) (P 0.437), resistive pressure (PResist) (P 0.410) and resistance (P 0.071). The multivariate analysis of mechanical power, plateau pressure (PPlateau), tidal volume (VT), driving pressure (ΔP) and elastance, showed that only mechanical power correlated to death (P 0.04) and for each additional unit in J/minute there is a 6.2% increase in the odds of death (95% IC 0.3%; 12.4%).

Conclusion

There are correlations between mechanical power and its components, except for compliance, elastance, resistance, and age. There is interference in the outcome in the univariate analysis of age, as well as of mechanical power and its components, except PEEP, Ve, PResist and resistance, but the multivariate analysis showed that only mechanical power correlates with the outcome in SARS-CoV-2 undergoing PCV.

Keywords

SARS-CoV-2 infection; Mortality; Ventilation Induced Lung Injury; Acute Respiratory Distress Syndrome

References

1. Gibson PG, Qin L, Puah SH. COVID-19 acute respiratory distress syndrome (ARDS): clinical features and differences from typical pre-COVID-19 ARDS. Med J Aust. 2020; 213(2):54-56.e1.
https://doi.org/10.5694/mja2.50674
PMid:32572965 PMCid:PMC7361309
2. Vasques F, Duscio E, Pasticci I, et al. Is the mechanical power the final word on ventilator-induced lung injury? we are not sure. Annals of translational medicine 2018; 6(19)395:1-6.
https://doi.org/10.21037/atm.2018.08.17
PMid:30460269 PMCid:PMC6212351
3. Silva PL, Ball L, Rocco PRM, et al. Power to mechanical power to minimize ventilator-induced lung injury? Intensive Care Medicine Experimental 2019; 7(38): 1-11.
https://doi.org/10.1186/s40635-019-0243-4
PMid:31346828 PMCid:PMC6658623
4. Marini JJ, Gattinoni L. Time course of evolving ventilator induced lung injury. The “Shrinking baby lung”. Crit Care Med 2020; 48(8):1203-1209.
https://doi.org/10.1097/CCM.0000000000004416
PMid:32697492 PMCid:PMC7217130
5. Marini JJ, Rocco PRM. Which component of mechanical power is the most important in causing VILI? Critical Care. 2020; 24(39): 1-3.
https://doi.org/10.1186/s13054-020-2747-4
PMid:32024538 PMCid:PMC7003372
6. Saffaran S, Das A, Laffey JG, et al. Utility of driving pressure and mechanical power to guide protective ventilator settings in two cohorts of adult and pediatric patients with acute respiratory distress syndrome: A computational investigation Crit Care Med 2020; 48(7):1001-1008.
https://doi.org/10.1097/CCM.0000000000004372
PMid:32574467
7. Ferrando C, Suarez-Sipmann F, Mellado-Artigas R et al. COVID-19 Spanish ICU Network. Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS. Intensive Care Med 2020; 46(12):2200-2211.
https://doi.org/10.1007/s00134-020-06192-2
PMid:32728965 PMCid:PMC7387884
8.Brochard L, Bersten A. Mechanical power a biomarker for the lung? Anesthesioly 2019; 130 (1):9-11.
https://doi.org/10.1097/ALN.0000000000002505
PMid:30383544
9. Chi Y, He HW, Long Y. Progress of mechanical power in the intensive care unit. Chin Med J 2020; 133(18):2197-2204.
https://doi.org/10.1097/CM9.0000000000001018
PMid:32842009 PMCid:PMC7508452
10. Marini JJ, Rocco PRM, Gattinoni L. Static and dynamic contributors to VILI in clinical practice: pressure, energy, and power. Am J Respir Crit Care Med 2020; 201(7):767-774.
https://doi.org/10.1164/rccm.201908-1545CI
PMid:31665612 PMCid:PMC7124710
11. Marini JJ, Gattinoni L, Rocco PRM. Estimating the Damaging Power of High-Stress Ventilation. Respir Care 2020; 65(7):1046-1052.
https://doi.org/10.4187/respcare.07860
PMid:32606007
12. Chiumello D, Gotti M, Guanziroli M. et al. Bedside calculation of mechanical power during volume- and pressure-controlled mechanical ventilation. Crit Care 2020; 24:417.
https://doi.org/10.1186/s13054-020-03116-w
PMid:32653011 PMCid:PMC7351639
13. Becher T, van der Staay M, Schädler D, et al. Calculation of mechanical power for pressure-controlled ventilation. Intensive Care Med 2019; 45(9):1321-1323.
https://doi.org/10.1007/s00134-019-05636-8
PMid:31101961
14. van der Meijden S, Molenaar M, Somhorst P, et al. Calculating mechanical power for pressure-controlled ventilation. Intensive Care Med 2019 45(10):1495-1497.
https://doi.org/10.1007/s00134-019-05698-8
PMid:31359082
15. Giosa L, Busana M, Pasticci I, et al. Mechanical power at a glance: a simple surrogate for volume-controlled ventilation. Intensive care medicine experimental 2019; 7(1):61.
https://doi.org/10.1186/s40635-019-0276-8
PMid:31773328 PMCid:PMC6879677
16. Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med 2016 42(10):1567-1575.
https://doi.org/10.1007/s00134-016-4505-2
PMid:27620287
17. Marini JJ. Dissipation of energy during the respiratory cycle: conditional importance of ergotrauma to structural lung damage. Curr Opin Crit Care 2018; 24(1):16-22.
https://doi.org/10.1097/MCC.0000000000000470
PMid:29176330
18. Alharthy A, Aletreby W, Faqihi F, et al. Clinical characteristics and predictors of 28-Day mortality in 352 critically ill patients with COVID-19: A retrospective study. J Epidemiol Glob Health 2021; 11(1):98-104.
https://doi.org/10.2991/jegh.k.200928.001
PMid:33095982 PMCid:PMC7958266
19. Franck CL, Franck GM, Feronato RG. Influence of age, mechanical power, its fragments, and components on the mortality rate in SARS-CoV-2 patients undergoing mechanical ventilation. J Mech Vent 2022; 3(1):1-12.
https://doi.org/10.53097/JMV.10041
20. Barnes T, Enk D. Ventilation for low dissipated energy achieved using flow control during both inspiration and expiration. Trends in Anaesthesia and Critical Care 2019; 24:5-12.
https://doi.org/10.1016/j.tacc.2018.09.003
21. Yeo J, Shah P, Koichi K, et al. Mechanical power in AVM-2 versus conventional ventilation modes in in various ARDS lung models: A bench study. J Mech Vent 2022; 3(3):110-122.
https://doi.org/10.53097/JMV.10056
22. Serpa Neto A, Deliberato RO, Johnson AEW, et al. PROVE Network Investigators. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med 2018; 44(11):1914-1922.
https://doi.org/10.1007/s00134-018-5375-6
PMid:30291378
23. Chacko B, Peter JV, Tharyan P, et al. Pressure-controlled versus volume-controlled ventilation for acute respiratory failure due to acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). Cochrane Database Syst Rev 2015; 1(1):CD008807.
24. Vassalli F, Pasticci I, Romitti F, et al. Does Iso-mechanical Power Lead to Iso-lung Damage? An Experimental Study in a Porcine Model. Anesthesiology 2020; 132(5):1126-1137.
https://doi.org/10.1097/ALN.0000000000003189
PMid:32032095
25. Coppola S, Caccioppola A, Froio S, et al. Effect of mechanical power on intensive care mortality in ARDS patients. Crit Care 2020; 24:246.
 10.1186/s13054-020-02963-x
PMID: 32448389 PMCID: PMC7245621