Mechanical Power in Prone Position Intubated Patients with COVID-19-Related ARDS: A Cohort Study

Overview

Journal Crit Care Res Pract

Publisher Wiley

Specialty Critical Care

Date 2023 Mar 13

PMID 36911499

Authors

Roberto Stalla Alves da Fonseca

Viviane Martins Correa Boniatti

Michelle Carneiro Teixeira

Alessandra Preisig Werlang

Francielle Martins

Pedro Henrique Rigotti Soares

Leonardo da Silva Marques

Wagner Luis Nedel

Affiliations

Soon will be listed here.

Abstract

Background: Respiratory monitoring of mechanical ventilation (MV) is relevant and challenging in COVID-19. Mechanical power (MP) is a novel and promising monitoring tool in acute distress respiratory syndrome (ARDS), representing the amount of energy transferred from the ventilator to the patient. It encompasses several setting parameters and patient-dependent variables that could cause lung injury. MP can therefore be an additional tool in the assessment of these patients.

Objective: This study aims to evaluate respiratory monitoring through MP and its relationship with mortality in patients with COVID-19-related ARDS (CARDS) under mechanical ventilation (MV) and prone position (PP) strategies.

Methods: Retrospective, unicentric, and cohort studies. We included patients with CARDS under invasive MV and PP strategies. Information regarding MP, ventilation, and gas exchange was collected at 3 moments: (1) prior to the first PP, (2) during the first PP, and (3) during the last PP. We tested the relationship between MP and VR with in-hospital mortality.

Results: We included 91 patients. There was a statistically significant difference in MP measurements between survivors and nonsurvivors only in the last prone position ( < 0.001). This is due to the significant increase in MP measurements in nonsurvivors (difference from the baseline: 3.63 J/min; 95% CI: 0.31 to 6.94), which was not observed in the group that survived (difference from the baseline: 0.02 J/min; 95% CI: -2.66 to 2.70). In multivariate analysis, MP (=0.009) was associated with hospital death when corrected for confounder variables (SAPS 3 score, mechanical ventilation time, age, and number of prone sessions).

Conclusions: MP is an independent predictor of mortality in PP patients with CARDS.

Citing Articles

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References

Silva P, Ball L, Rocco P, Pelosi P . Power to mechanical power to minimize ventilator-induced lung injury?. Intensive Care Med Exp. 2019; 7(Suppl 1):38. PMC: 6658623. DOI: 10.1186/s40635-019-0243-4. View

Schuijt M, Schultz M, Paulus F, Serpa Neto A . Association of intensity of ventilation with 28-day mortality in COVID-19 patients with acute respiratory failure: insights from the PRoVENT-COVID study. Crit Care. 2021; 25(1):283. PMC: 8343355. DOI: 10.1186/s13054-021-03710-6. View

Ferrando C, Suarez-Sipmann F, Mellado-Artigas R, Hernandez M, Gea A, Arruti E . 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. PMC: 7387884. DOI: 10.1007/s00134-020-06192-2. View

Silva P, Pelosi P, Rocco P . Understanding the Mysteries of Mechanical Power. Anesthesiology. 2020; 132(5):949-950. DOI: 10.1097/ALN.0000000000003222. View

. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2020; 47(1):60-73. PMC: 7674575. DOI: 10.1007/s00134-020-06294-x. View

Scaramuzzo G, Gamberini L, Tonetti T, Zani G, Ottaviani I, Mazzoli C . Sustained oxygenation improvement after first prone positioning is associated with liberation from mechanical ventilation and mortality in critically ill COVID-19 patients: a cohort study. Ann Intensive Care. 2021; 11(1):63. PMC: 8072095. DOI: 10.1186/s13613-021-00853-1. View

Ranieri V, Rubenfeld G, Thompson B, Ferguson N, Caldwell E, Fan E . Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012; 307(23):2526-33. DOI: 10.1001/jama.2012.5669. View

Scaramuzzo G, Karbing D, Fogagnolo A, Mauri T, Spinelli E, Mari M . Heterogeneity of Ventilation/Perfusion Mismatch at Different Levels of PEEP and in Respiratory Mechanics Phenotypes of COVID-19 ARDS. Respir Care. 2022; 68(2):188-198. PMC: 9994283. DOI: 10.4187/respcare.10242. View

Cressoni M, Gotti M, Chiurazzi C, Massari D, Algieri I, Amini M . Mechanical Power and Development of Ventilator-induced Lung Injury. Anesthesiology. 2016; 124(5):1100-8. DOI: 10.1097/ALN.0000000000001056. View

10.

Tonetti T, Vasques F, Rapetti F, Maiolo G, Collino F, Romitti F . Driving pressure and mechanical power: new targets for VILI prevention. Ann Transl Med. 2017; 5(14):286. PMC: 5537108. DOI: 10.21037/atm.2017.07.08. View

11.

Marini J, Gattinoni L . Management of COVID-19 Respiratory Distress. JAMA. 2020; 323(22):2329-2330. DOI: 10.1001/jama.2020.6825. View

12.

Weiss C, McSparron J, Chatterjee R, Herman D, Fan E, Wilson K . Summary for Clinicians: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome Clinical Practice Guideline. Ann Am Thorac Soc. 2017; 14(8):1235-1238. PMC: 5566274. DOI: 10.1513/AnnalsATS.201704-332CME. View

13.

Brower R, Matthay M, Morris A, Schoenfeld D, Thompson B, Wheeler A . Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000; 342(18):1301-8. DOI: 10.1056/NEJM200005043421801. View

14.

Guerin C, Reignier J, Richard J, Beuret P, Gacouin A, Boulain T . Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013; 368(23):2159-68. DOI: 10.1056/NEJMoa1214103. View

15.

Chiumello D, Bonifazi M, Pozzi T, Formenti P, Sferrazza Papa G, Zuanetti G . Positive end-expiratory pressure in COVID-19 acute respiratory distress syndrome: the heterogeneous effects. Crit Care. 2021; 25(1):431. PMC: 8674862. DOI: 10.1186/s13054-021-03839-4. View

16.

Serpa Neto A, Deliberato R, Johnson A, Bos L, Amorim P, Pereira S . 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. DOI: 10.1007/s00134-018-5375-6. View

17.

Boesing C, Graf P, Schmitt F, Thiel M, Pelosi P, Rocco P . Effects of different positive end-expiratory pressure titration strategies during prone positioning in patients with acute respiratory distress syndrome: a prospective interventional study. Crit Care. 2022; 26(1):82. PMC: 8962042. DOI: 10.1186/s13054-022-03956-8. View

18.

Papazian L, Munshi L, Guerin C . Prone position in mechanically ventilated patients. Intensive Care Med. 2022; 48(8):1062-1065. PMC: 9160174. DOI: 10.1007/s00134-022-06731-z. View

19.

Gleissman H, Forsgren A, Andersson E, Lindqvist E, Lipka Falck A, Cronhjort M . Prone positioning in mechanically ventilated patients with severe acute respiratory distress syndrome and coronavirus disease 2019. Acta Anaesthesiol Scand. 2020; 65(3):360-363. PMC: 7894343. DOI: 10.1111/aas.13741. View

20.

Gattinoni L, Tonetti T, Cressoni M, Cadringher P, Herrmann P, Moerer O . Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016; 42(10):1567-1575. DOI: 10.1007/s00134-016-4505-2. View