Ventilator-related causes of lung injury: the mechanical power
By L. Gattinoni, T. Tonetti, M. Cressoni, P. Cadringher, P. Herrmann, O. Moerer, A. Protti, M. Gotti, C. Chiurazzi, E. Carlesso and 2 more. Intensive Care Medicine, 2016
826 citations recorded by the source corpus.
PurposeWe hypothesized that the ventilator-related causes of lung injury may be unified in a single variable: the mechanical power. We assessed whether the mechanical power measured by the pressure–volume loops can be computed from its components: tidal volume (TV)/driving pressure (∆Paw), flow, positive end-expiratory pressure (PEEP), and respiratory rate (RR). If so, the relative contributions of each variable to the mechanical power can be estimated.MethodsWe computed the mechanical power by multiplying each component of the equation of motion by the variation of volume and RR: $${\text{Power}}_{\text{rs}} = {\text{RR}} \cdot \left\{ {\Delta V^{2} \cdot \left[ {\frac{1}{2} \cdot {\text{EL}}_{\text{rs}} + {\text{RR}} \cdot \frac{{\left( {1 + I:E} \right)}}{60 \cdot I:E} \cdot R_{\text{aw}} } \right] + \Delta V \cdot {\text{PEEP}}} \right\},$$Powerrs=RR·ΔV2·12·ELrs+RR·1+I:E60·I:E·Raw+ΔV·PEEP,where ∆V is the tidal volume, ELrs is the elastance of the respiratory system, I:E is the inspiratory-to-expiratory time ratio, and Raw is the airway resistance. In 30 patients with normal lungs and in 50 ARDS patients, mechanical power was computed via the power equation and measured from the dynamic pressure–volume curve at 5 and 15 cmH2O PEEP and 6, 8, 10, and 12 ml/kg TV. We then computed the effects of the individual component variables on the mechanical power.ResultsComputed and measured mechanical powers were similar at 5 and 15 cmH2O PEEP both in normal subjects and in ARDS patients (slopes = 0.96, 1.06, 1.01, 1.12 respectively, R2 > 0.96 and p < 0.0001 for all). The mechanical power increases exponentially with TV, ∆Paw, and flow (exponent = 2) as well as with RR (exponent = 1.4) and linearly with PEEP.ConclusionsThe mechanical power equation may help estimate the contribution of the different ventilator-related causes of lung injury and of their variations. The equation can be easily implemented in every ventilator’s software.
Subfields: Critical Care and Intensive Care Medicine, Pulmonary and Respiratory Medicine
View Paper: https://www.semanticscholar.org/paper/123f33355887252145be0c5b6b6733e15eaa1408
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In Critical Care and Intensive Care Medicine
In Pulmonary and Respiratory Medicine
Citations in the corpus
- The intensive care medicine research agenda for airways, invasive and noninvasive mechanical ventilation (2017, background): “Recently, it was suggested that an inclusive single variable, the mechanical power, might summarize all mechanical stressors shown experimentally and by observation to injure the lungs during mechanical ventilation [60].”
- Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study (2020, neutral): “098 × tidal volume × respiratory rate × (peak pressure − 1/2 × driving pressure) [11].”
- Focus on ventilation and airway management in the ICU (2017, methodology): “The mechanical power is computed by multiplying each component of the equation of motion by the variation in volume and respiratory rate: the formula includes the tidal volume, respiratory rate, PEEP, elastance of the respiratory system, inspiratory-toexpiratory time ratio, and airway resistance [1,”