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Available online 23 July 2025
Association between time weighted average mechanical power normalized to compliance and prognosis of critically ill patients: A retrospective cohort study based on the MIMIC-IV database
Asociación entre la potencia mecánica promedio ponderada en el tiempo normalizada al cumplimiento y el pronóstico de pacientes críticos: un estudio de cohorte retrospectivo basado en la base de datos MIMIC-IV
Yukang Donga,b,, Guiyun Lic,, Jiangquan Fud, Rui Huangd, Huan Yaoe,f, Jingni Wanga, Ying Wanga, Feng Shena,
a Department of Intensive Care Unit, Guizhou Medical University Affiliated Hospital, Guiyang, China
b Department of Emergency, Guizhou Provincial People’s Hospital, Guiyang, China
c Department of Emergency, The Second People's Hospital of Guiyang, Guiyang, China
d Department of Emergency Intensive Care Unit, Guizhou Medical University Affiliated Hospital, Guiyang, China
e Xiangya School of Nursing, Central South University, Changsha, Hunan, China
f Nursing Department, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China
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Table 1. Baseline characteristics and clinical outcomes of the included patients.
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Table 2. Multivariable logistic regression analyses of TWA-MPCRS and ICU and in-hospital mortality.
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Abstract
Objective

This study aims to evaluate the association of time‑weighted average mechanical power normalized to compliance (TWA-MPCRS) with all-cause mortality to determine its value as a prognostic tool in intensive care patients.

Design

Retrospective observational study.

Setting

Intensive care unit (ICU).

Patients or participants

4387 first-time ICU-admitted patients in the Medical Information Mart for Intensive Care (MIMIC) IV.

Interventions

None.

Main variables of interest

TWA-MPCRS, ICU mortality and in-hospital mortality.

Results

Participants' mean age was 61.4 ± 16.9 years and the median [IQR] baseline TWA-MPCRS was 0.3 (0.2, 0.6) J/min/mL/cmH2O. When TWA-MPCRS was divided into quintiles (with quintile 1 representing the lowest values), after adjusting for covariates, the odds ratios [95% confidence intervals (CIs)] for ICU mortality were 1.49 (95% CI: 1.15–1.94), 1.67 (95% CI: 1.29–2.16), 1.79 (95% CI: 1.37–2.33), and 3.96 (95% CI: 3.01–5.21) for quintiles 2, 3, 4, and 5 respectively, with quintile 1 as reference. Similar results were found for hospital mortality.

Conclusion

Higher TWA-MPCRS is associated with poor clinical outcomes in critically ill patients. Higher TWA-MPCRS can lead to a higher mortality among ICU and in-hospital patients.

Keywords:
Critically ill
Mechanical ventilation
Mechanical power normalized to compliance
Retrospective cohort study
MIMIC IV
Abbreviations:
ARDS
AUC
BMI
bpm
COPD
CRS
FiO2
ICU
IQR
MAP
MIMIC
MP
OR
PaCO2
PaO2
PBW
PEEP
PF
Ppeak
ROC
RRT
SAPS
SD
SOFA
SpO2
SQL
TWA
VIF
VILI
Vt
Resumen
Objetivo

Este estudio tiene como objetivo evaluar la asociación entre la potencia mecánica promedio en el tiempo y normalizada por la complianza (TWA-MPCRS) y la mortalidad por todas las causas, con el fin de determinar su valor como herramienta pronóstica en pacientes de cuidados intensivos.

Diseño

Estudio observacional retrospectivo.

Entorno

Unidad de Cuidados Intensivos (UCI).

Pacientes o participantes

4387 pacientes ingresados por primera vez en la UCI, seleccionados de la base de datos Medical Information Mart for Intensive Care (MIMIC) IV.

Intervenciones

Ninguna.

Variables de interés principales

TWA-MPCRS, mortalidad en la UCI y mortalidad hospitalaria.

Resultados

La edad promedio de los participantes fue de 61.4 ± 16.9años, y la mediana [IQR] de TWA-MPCRS basal fue de 0.3 (0.2, 0.6) J/min/mL/cmH2O. Cuando el TWA-MPCRS se dividió en quintiles (siendo el quintil 1 el de los valores más bajos), tras ajustar por covariables, las razones de odds [intervalos de confianza (IC) del 95%] para la mortalidad en UCI fueron 1.49 (IC 95%: 1.15–1.94), 1.67 (IC 95%: 1.29–2.16), 1.79 (IC 95%: 1.37–2.33) y 3.96 (IC 95%: 3.01–5.21) para los quintiles 2, 3, 4 y 5, respectivamente, teniendo el quintil 1 como referencia. Se encontraron resultados similares para la mortalidad hospitalaria.

Conclusión

Un TWA-MPCRS más alto se asocia con peores resultados clínicos en pacientes críticos. Un TWA-MPCRS más elevado puede conducir a una mayor mortalidad entre los pacientes en la UCI y en el hospital.

Palabras clave:
Pacientes críticos
Ventilación mecánica
Potencia mecánica normalizada por complianza
Estudio de cohorte retrospectivo
MIMIC IV

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