Editorial
Mechanical Power or the not harming power
Potencia mecánica o el poder de no hacer daño
a Critical Care Department, Althaia Xarxa Assistencial Universitària Manresa, Manresa, Barcelona, Spain
b Grupo 33, Centro de Investigaciones Biomédicas en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
c Institut d'Investigació i Innovació I3PT, Sabadell, Spain
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"⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Potencia mecánica o el poder de no hacer daño" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">For decades, the material sciences (rheology) have been applied to mechanical ventilation (MV), and calculations have been made of the work burden for the respiratory system associated with breathing through a ventilator. In this context, the lung is regarded as a viscoelastic element, and mathematical models have been used to describe the relationship between the tension (<span class="elsevierStyleItalic">stress</span>) upon the respiratory system during ventilation and its corresponding deformation (<span class="elsevierStyleItalic">strain</span>).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Gattinoni et al. defined mechanical power (MP) as the energy transmitted to the respiratory system per unit time (in J/min). In patients subjected to volume control ventilation (VCV), they calculated MP by multiplying each component of the classical equation of motion by volume variation and respiratory rate – thereby including the contribution of different MV-related factors in lung injury.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a><elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0015" class="elsevierStylePara elsevierViewall">RR: respiratory rate; ΔV: tidal volume; ELrs: elastance of the respiratory system; I:E: inspiratory/expiratory time; Raw: airway resistance; PEEP: positive end-expiratory pressure</p><p id="par0020" class="elsevierStylePara elsevierViewall">These same investigators demonstrated a correlation between ventilator-induced lung injury (VILI) and MP, and even defined an injury threshold.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Mechanical power increases exponentially with tidal volume, driving pressure (DP), flow and respiratory rate, and increases linearly with positive end-expiratory pressure (PEEP) and airway resistance (R<span class="elsevierStyleInf">aw</span>) – these parameters being described as factors associated with mortality in ventilated patients in the multicenter LUNG SAFE cohort.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Since then, several simplified versions of the formula developed by Gattinoni et al. have been introduced, as well as specific formulas for pressure control ventilation (PCV) modes, since the equation for calculating MP in VCV is based on a linear increase in airway pressure (P<span class="elsevierStyleInf">aw</span>) during inspiration, which is not adequate in PCV modes.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> Assuming an ideal square curve of P<span class="elsevierStyleInf">aw</span> during inspiration in PCV, the calculation of MP is based on the inspiratory pressure gradient (P<span class="elsevierStyleInf">insp</span>).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The problem with so many formulas is that some authors have reported broad variations in MP depending on the formula used to calculate it</p><p id="par0035" class="elsevierStylePara elsevierViewall">The present issue of <span class="elsevierStyleItalic">Medicine Intensiva</span> publishes a study on the prevalence of elevated MP in patients subjected to MV in routine clinical practice. This international, multicenter observational study involved a cohort of 372 patients from 133 Intensive Care Units (ICUs) in 15 countries. Most of the patients required intubation and MV due to acute respiratory failure (33%) or neurological disorders (31%).</p><p id="par0040" class="elsevierStylePara elsevierViewall">As the main finding of the study, the patients ventilated in PCV mode presented greater MP than those ventilated in VCV mode (19 and 16 J/min, respectively). Thirty-eight percent of the patients presented MP > 17 J/min, with no statistically significant differences between the PCV and VCV modes. This study thus evidences the high prevalence of potentially harmful MP in our routine clinical practice.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The difference in MP between the PCV and VCV modes found by the authors is consistent with previous data found in the literature. An explanation for these observations would be that the amount of energy distributed by the ventilator varies due to the difference between flow patterns, leading to different P/V curves P/V.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Furthermore, greater transpulmonary pressure gradients have been reported in PCV versus VCV mode.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In the same way that Amato et al. have shown a driving pressure (DP) of > 15cmH<span class="elsevierStyleInf">2</span>O to be more significantly associated with mortality in patients with acute respiratory distress syndrome (ARDS) than plateau pressure (P<span class="elsevierStyleInf">plateau</span>), recent studies suggest that MP values of > 18−20 J/min are also associated to increased mortality.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">But is the calculation of mechanical power really necessary?</p><p id="par0060" class="elsevierStylePara elsevierViewall">Guérin et al. observed a linear relationship between DP, MP, P<span class="elsevierStyleInf">plateau</span> and compliance in patients with ARDS subjected to protective ventilation.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However, since MP is derived from the equation of motion, it incorporates additional parameters not included in DP, such as flow or respiratory rate, which can impact mortality in patients with ARDS.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> It thus affords an additional risk estimate beyond DP alone. Prospective studies are needed to examine the effect of a ventilatory strategy upon controlled MP versus the DP management strategy, though it would be interesting to have continuous MP monitoring at the patient bedside to minimize the damage induced by MV.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The study also contemplates the investigation of different components of MP, establishing the surrogate parameters that best represent lung response to ventilation. Based on this, mathematical models are established for each ventilation mode, choosing the best option using the Akaike Information Criterion (AIC) tool. The AIC estimates the error of prediction of the relative quality of statistical models for a given set of data. The models best assessed by the AIC system contain strain and strain rate surrogates as in previous studies, reflecting this viscoelastic component of the lung.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Although the mentioned study is observational, its strengths lie in the large sample size involved and the participation of 15 different ICUs, with the added novelty of using AIC as a statistical tool for determining the best way to calculate MP.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Mechanical power is little used as a tool, due to the difficulty of calculating it in the routine clinical practice setting. It therefore would be advisable for automated systems to perform continuous calculation of this variable. Another consideration is how to incorporate it into the daily activity of the professionals. The LUNG SAFE study has recently evidenced the scant presence of DP in clinical practice, despite its simplicity. We thus encourage professionals to delve into it through this study and to calculate it in their ventilated patients as a complementary variable for adjusting the ventilator. Regardless of whether we prefer DP or MP, in the end our goal must be to reduce MV-induced injury, based on the classical principle “<span class="elsevierStyleItalic">primum non nocere</span>”.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0080" class="elsevierStylePara elsevierViewall">Not applicable.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">Not applicable.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara" id="npar0005">See related article: <span class="elsevierStyleInterRef" id="intr2005" href="doi:10.1016/j.medine.2023.11.004">https://doi.org/10.1016/j.medine.2023.11.004</span></p>" ] ] "multimedia" => array:1 [ 0 => array:5 [ "identificador" => "eq0005" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "Powerrs=RRΔV212ELrs+RR1+I:E60.I:E+ΔV.PEEP" "Fichero" => "STRIPIN_si1.jpeg" "Tamanyo" => 2190 "Alto" => 18 "Ancho" => 240 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stress, strain y potencia mecánica. ¿Es la ingeniería de materiales la respuesta para prevenir la lesión inducida por el ventilador?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Modesto i Alapont" 1 => "M. Aguar Carrascosa" 2 => "A. Medina Villanueva" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2018.06.008" "Revista" => array:2 [ "tituloSerie" => "Med Intensiva." "fecha" => "2019" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilator-related causes of lung injury: the mechanical power" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Gattinoni" 1 => "T. Tonetti" 2 => "M. Cressoni" 3 => "P. Cadringher" 4 => "P. Herrmann" 5 => "O. Moerer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-016-4505-2" "Revista" => array:7 [ "tituloSerie" => "Intensive Care Med." "fecha" => "2016" "volumen" => "42" "numero" => "10" "paginaInicial" => "1567" "paginaFinal" => "1575" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27620287" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanical power and development of ventilator-induced lung injury" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Cressoni" 1 => "M. Gotti" 2 => "C. Chiurazzi" 3 => "D. Massari" 4 => "I. Algieri" 5 => "M. Amini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0000000000001056" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology." "fecha" => "2016" "volumen" => "124" "numero" => "5" "paginaInicial" => "1100" "paginaFinal" => "1108" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "LUNG SAFE Investigators; ESICM Trials Group" "etal" => true "autores" => array:6 [ 0 => "G. Bellani" 1 => "J.G. Laffey" 2 => "T. Pham" 3 => "E. Fan" 4 => "L. Brochard" 5 => "A. Esteban" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2016.0291" "Revista" => array:7 [ "tituloSerie" => "JAMA" "fecha" => "2016" "volumen" => "315" "numero" => "8" "paginaInicial" => "788" "paginaFinal" => "800" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26903337" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanical power at a glance: a simple surrogate for volume-controlled ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Giosa" 1 => "M. Busana" 2 => "I. Pasticci" 3 => "M. Bonifazi" 4 => "M.M. Macrì" 5 => "F. Romitti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s40635-019-0276-8" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med Exp." "fecha" => "2019" "volumen" => "7" "numero" => "1" "paginaInicial" => "61" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31773328" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bedside dynamic calculation of mechanical power: a validation study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Aşar" 1 => "Ö Acicbe" 2 => "Z. Çukurova" 3 => "G.O. Hergünsel" 4 => "E. Canan" 5 => "N. Çakar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrc.2019.12.027" "Revista" => array:6 [ "tituloSerie" => "J Crit Care." "fecha" => "2020" "volumen" => "56" "paginaInicial" => "167" "paginaFinal" => "170" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31931417" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Calculation of mechanical power for pressure-controlled ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Becher" 1 => "M. van der Staay" 2 => "D. Schädler" 3 => "I. Frerichs" 4 => "N. Weiler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-019-05636-8" "Revista" => array:7 [ "tituloSerie" => "Intensive Care Med." "fecha" => "2019" "volumen" => "45" "numero" => "9" "paginaInicial" => "1321" "paginaFinal" => "1323" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31101961" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanical power differs between pressure-controlled ventilation and different volume-controlled ventilation modes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.J. Rietveld" 1 => "J.W.M. Snoep" 2 => "M. Lamping" 3 => "F. van der Velde" 4 => "E. de Jonge" 5 => "D.W. van Westerloo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCE.0000000000000741" "Revista" => array:6 [ "tituloSerie" => "Crit Care Explor." "fecha" => "2022" "volumen" => "4" "numero" => "8" "paginaInicial" => "e0741" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35982836" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "PROVE Network Investigators" "etal" => true "autores" => array:6 [ 0 => "A. Serpa Neto" 1 => "R.O. Deliberato" 2 => "A.E.W. Johnson" 3 => "L.D. Bos" 4 => "P. Amorim" 5 => "S.M. Pereira" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-018-5375-6" "Revista" => array:7 [ "tituloSerie" => "Intensive Care Med." "fecha" => "2018" "volumen" => "44" "numero" => "11" "paginaInicial" => "1914" "paginaFinal" => "1922" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30291378" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of driving pressure on mortality in ARDS patients during lung protective mechanical ventilation in two randomized controlled trials" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "investigators of the Acurasys and Proseva trials" "etal" => false "autores" => array:6 [ 0 => "C. Guérin" 1 => "L. Papazian" 2 => "J. Reignier" 3 => "L. Ayzac" 4 => "A. Loundou" 5 => "J.M. Forel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13054-016-1556-2" "Revista" => array:6 [ "tituloSerie" => "Crit Care." "fecha" => "2016" "volumen" => "20" "numero" => "1" "paginaInicial" => "384" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27894328" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanical power and driving pressure as predictors of mortality among patients with ARDS" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "University of Utah Mechanical Power Study Group" "etal" => false "autores" => array:5 [ 0 => "J.E. Tonna" 1 => "I. Peltan" 2 => "S.M. Brown" 3 => "J.S. Herrick" 4 => "H.T. Keenan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-020-06130-2" "Revista" => array:7 [ "tituloSerie" => "Intensive Care Med." "fecha" => "2020" "volumen" => "46" "numero" => "10" "paginaInicial" => "1941" "paginaFinal" => "1943" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32504104" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004800000003/v1_202403010851/S2173572724000018/v1_202403010851/en/main.assets" "Apartado" => array:4 [ "identificador" => "406" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004800000003/v1_202403010851/S2173572724000018/v1_202403010851/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572724000018?idApp=WMIE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 60 | 48 | 108 |
| 2024 September | 97 | 41 | 138 |
| 2024 August | 96 | 44 | 140 |
| 2024 July | 75 | 30 | 105 |
| 2024 June | 82 | 34 | 116 |
| 2024 April | 1 | 2 | 3 |
| 2024 March | 2 | 0 | 2 |
