Mechanical power is not associated with mortality in COVID-19 mechanically ventilated patients
Authors: Barbeta Enric , Barreiros Cláudia , Forin Edoardo , Guzzardella Amedeo , Motos Anna , Fernández-Barat Laia , Gabarrús Albert , Ceccato Adrián , Ferrer Ricard , Riera Jordi , Peñuelas Oscar , Lorente José Ángel , de Gonzalo-Calvo David , Gonzalez Jessica , Amaya-Villar Rosario , Añón José Manuel , Balan Ana , Barberà Carme , Barberán José , Blandino Aaron , Boado Maria Victoria , Bustamante-Munguira Elena , Caballero Jesús , Cantón-Bulnes María Luisa , Carbajales Cristina , Carbonell Nieves , Catalán-González Mercedes , Franco Nieves , Galbán Cristóbal , Gumucio-Sanguino Víctor D. , de la Torre Maria Del Carmen , Díaz Emilio , Estella Ángel , Gallego Elena , Gómez José Manuel , Huerta Arturo , García Ruth Noemí Jorge , Loza-Vázquez Ana , Marin-Corral Judith , Delgado María Cruz Martin , Martínez Amalia , Martínez Ignacio , Lopez Juan , Albaiceta Guillermo M. , Nieto María Teresa , Novo Mariana Andrea , Peñasco Yhivian , Pérez-García Felipe , Ricart Pilar , Rodríguez Alejandro , Sagredo Victor , Sánchez-Miralles Angel , Sancho Susana , Roche-Campo Ferran , Socias Lorenzo , Solé-Violan Jordi , Tamayo Luis , Trenado José , Úbeda Alejandro , Valdivia Luis Jorge , Vidal Pablo , Barbé Ferran , Vallverdú Jordi , Torres Antoni ,   CIBERESUCICOVID Project investigators (COV20/00110, ISCIII), Adell-Serrano Berta , Agrifoglio Alexander , Cabello María Aguilar , Aguilera Luciano , Alcaraz-Serrano Victoria , Aldecoa Cesar , Alegre Cynthia , Álvarez Sergio , Ruiz Antonjo Álvarez , Andrea Rut , Ángel José , Arrieta Marta , Ayestarán J. Ignacio , Badia Joan Ramon , Badía Mariona , Pravia Orville Báez , Balsera Begoña , Barbena Laura , Bardi Tommaso , Segade Patricia Barral , Barroso Marta , García José Ángel Berezo , Bigas Judit , Blancas Rafael , Cortés María Luisa Blasco , Boado María , Saera María Bodi , Bofill Neus , Vieiro María Teresa Bouza , Bueno Leticia , Bustamante-Munguira Juan , Cachafeiro Lucia , Hermoso David Campi , Fernández Sandra Campos , Cano Iosune , Cantón-Bulnes Maria Luisa , Fernández Pablo Cardina , García Laura Carrión , Carvalho Sula , Casacuberta-Barberà Núria , Castellà Manuel , Castellví Andrea , Castro Pedro , Ávila Ramon Cicuendez , Cillóniz Catia , Clar Luisa , Climent Cristina , Codina Jordi , Conde Pamela , Contreras Sofía , Martin María Cruz , de Pablo Sánchez Raul , De Mendoza Diego , del Busto Martínez Cecilia , Díaz Yolanda , Vilas María Digna Rivas , Moreno Cristina Dólera , Dot Irene , Giraudo Pedro Enríquez , Arijón Inés Esmorís , Monjo Teresa Farre , Fernández Javier , Ferrando Carlos , Figueras Albert , Forcadell-Ferreres Eva , Espina Lorena Forcelledo , Furro Àngels , García Felipe , García Beatriz , Prieto Emilio García , Redruello Carlos García , Sagastume Amaia García , Castillo Maria Luisa Gascón , Gomà Gemma , Casal Vanesa Gómez , Gómez Silvia , Gonzalez Carmen Gómez , González Jessica , Gordo Federico , Gracia Maria Pilar , Herraiz Alba , Herrán-Monge Rubén , Ibarz Mercedes , Iglesias Silvia , Janer Maria Teresa , Jiménez Gabriel , Díaz Mar Juan , Kiarostami Karsa , Álvarez Juan I. Lazo , León Miguel , López-Gavín Alexandre , Lago Ana López , Guerrero Desire Macias , Herrera Nuria Mamolar , Mendiluce Rafael Mañez , Mantellini Cecilia L , Naya Gregorio Marco , Marcos Pilar , Peis Enrique Marmol , Vicente Paula Martín , Martínez María , Fernández Carmen Eulalia Martínez , Juan Maria Dolores Martínez , Jimenez Juan Fernando Masa , Masclans Joan Ramon , Maseda Emilio , Fernández Eva María Menor , Miralbés Mar , Monclou Josman , Montejo-González Juan Carlos , Montserrat Neus , Aznar María Mora , Moral-Parras Pedro , Morales Dulce , Cano Sara Guadalupe Moreno , Rodríguez David Mosquera , Muñoz-Bermúdez Rosana , Nicolás José María , Bou Ramon Nogue , Salinas Rafaela Nogueras , Ocón Marta , Ortega Ana , Ossa Sergio , Pagliarani Pablo , Pous Anna Parera , Parrilla Francisco , Bastida Leire Pérez , Pérez Purificación , Planelles Gloria Pérez , Rubio Eva Pérez , Laguna David Pestaña , Piñol-Tena Àngels , Prados Javier , Pujol Andrés , Coll Núria Ramon , Sanchez-Giron Gloria Renedo , Rodriguez Laura , de Castro Felipe Rodríguez , Rodríguez Silvia , Ruiz Covadonga Rodríguez , Rubio Jorge , López Alberto Rubio , Miralles Miriam Ruiz , Murúa Pablo Ryan , Paz Eva Saborido , Degracia Ana Salazar , Sanchez Miguel , Sánchez Ana , Santacoloma Bitor , Sariñena Maria Teresa , Pensado Marta Segura , Serra Lidia , Serra-Fortuny Mireia , Lázaro Ainhoa Serrano , Servià Lluís , Soliva Laura , Speziale Carla , Tognetti Daniel , Tormos Adrián , Torres Mateu , Trefler Sandra , Trujillano Javier , Urrelo-Cerrón Luis , Val Estela , Ruiz Luis Valdivia , Vallverdú Montse , Van der Hofstadt Martin-Montalvo Maria , Adrio Sabela Vara , Vázquez Nil , Vengoechea Javier , Cortes Pablo Vidal , Vilà-Vilardel Clara , Vilanova Judit , Warrington Tatiana Villada , Yang Hua , Yang Minlan , Zapatero Ana , Vidal Júlia 
Published: February 2025

Abstract

Background
The relative contribution of the different components of mechanical power to mortality is a subject of debate and has not been studied in COVID-19. The aim of this study is to evaluate both the total and the relative impact of each of the components of mechanical power on mortality in a well-characterized cohort of patients with COVID-19-induced acute respiratory failure undergoing invasive mechanical ventilation. This is a secondary analysis of the CIBERESUCICOVID project, a multicenter observational cohort study including fifty Spanish intensive care units that included COVID-19 mechanically ventilated patients between February 2020 and December 2021. We examined the association between mechanical power and its components (elastic static, elastic dynamic, total elastic and resistive power) with 90-day mortality after adjusting for confounders in seven hundred ninety-nine patients with COVID-19-induced respiratory failure undergoing invasive mechanical ventilation.

Results
At the initiation of mechanical ventilation, the PaO2/FiO2 ratio was 106 (78; 150), ventilatory ratio was 1.69 (1.40; 2.05), and respiratory system compliance was 35.7 (29.2; 44.5) ml/cmH2O. Mechanical power at the initiation of mechanical ventilation was 24.3 (18.9; 29.6) J/min, showing no significant changes after three days. In multivariable regression analyses, mechanical power and its components were not associated with 90-day mortality at the start of mechanical ventilation. After three days, total elastic and elastic static power were associated with higher 90-day mortality, but this relationship was also found for positive end-expiratory pressure.

Conclusions
Neither mechanical power nor its components were independently associated with mortality in COVID-19-induced acute respiratory failure at the start of MV. Nevertheless, after three days, static elastic power and total elastic power were associated with lower odds of survival. Positive end-expiratory pressure and plateau pressure, however, captured this risk in a similar manner.