Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 6;25(1):13.
doi: 10.1186/s13054-020-03428-x.

Mechanical power during extracorporeal membrane oxygenation and hospital mortality in patients with acute respiratory distress syndrome

Li-Chung Chiu  1   2   3 , Shih-Wei Lin  1 , Li-Pang Chuang  1 , Hsin-Hsien Li  4   5 , Pi-Hua Liu  6   7 , Feng-Chun Tsai  8 , Chih-Hao Chang  1   3 , Chen-Yiu Hung  1   3 , Chung-Shu Lee  1 , Shaw-Woei Leu  1 , Han-Chung Hu  1   4   9 , Chung-Chi Huang  1   4   9 , Huang-Pin Wu  10 , Kuo-Chin Kao  11   12   13   14
Affiliations

Mechanical power during extracorporeal membrane oxygenation and hospital mortality in patients with acute respiratory distress syndrome

Li-Chung Chiu et al. Crit Care. .

Abstract

Background: Mechanical power (MP) refers to the energy delivered by a ventilator to the respiratory system per unit of time. MP referenced to predicted body weight (PBW) or respiratory system compliance have better predictive value for mortality than MP alone in acute respiratory distress syndrome (ARDS). Our objective was to assess the potential impact of consecutive changes of MP on hospital mortality among ARDS patients receiving extracorporeal membrane oxygenation (ECMO).

Methods: We performed a retrospective analysis of patients with severe ARDS receiving ECMO in a tertiary care referral center in Taiwan between May 2006 and October 2015. Serial changes of MP during ECMO were recorded.

Results: A total of 152 patients with severe ARDS rescued with ECMO were analyzed. Overall hospital mortality was 53.3%. There were no significant differences between survivors and nonsurvivors in terms of baseline values of MP or other ventilator settings. Cox regression models demonstrated that mean MP alone, MP referenced to PBW, and MP referenced to compliance during the first 3 days of ECMO were all independently associated with hospital mortality. Higher MP referenced to compliance (HR 2.289 [95% CI 1.214-4.314], p = 0.010) was associated with a higher risk of death than MP itself (HR 1.060 [95% CI 1.018-1.104], p = 0.005) or MP referenced to PBW (HR 1.004 [95% CI 1.002-1.007], p < 0.001). The 90-day hospital mortality of patients with high MP (> 14.4 J/min) during the first 3 days of ECMO was significantly higher than that of patients with low MP (≦ 14.4 J/min) (70.7% vs. 46.8%, p = 0.004), and the 90-day hospital mortality of patients with high MP referenced to compliance (> 0.53 J/min/ml/cm H2O) during the first 3 days of ECMO was significantly higher than that of patients with low MP referenced to compliance (≦ 0.53 J/min/ml/cm H2O) (63.6% vs. 29.7%, p < 0.001).

Conclusions: MP during the first 3 days of ECMO was the only ventilatory variable independently associated with 90-day hospital mortality, and MP referenced to compliance during ECMO was more predictive for mortality than was MP alone.

Keywords: Acute respiratory distress syndrome; Compliance; Extracorporeal membrane oxygenation; Functional lung size; Mechanical power; Mortality; Ventilator-induced lung injury.

PubMed Disclaimer

Conflict of interest statement

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Difference in mean values of MP and its determinants before and during the first 3 days of ECMO. *p < 0.001 compared between the mean values before ECMO and during the first 3 days of ECMO. ECMO, extracorporeal membrane oxygenation; MP, mechanical power; PEEP, positive end-expiratory pressure; Ppeak, peak inspiratory pressure; RR, respiratory rate; VT, tidal volume
Fig. 2
Fig. 2
a Hospital mortality as a function of mean mechanical power before ECMO initiation. b During the first 3 days of ECMO
Fig. 3
Fig. 3
Kaplan–Meier 90-day survival curves of patients undergoing ECMO for severe acute respiratory distress syndrome, as stratified by the optimal cutoff value of a MP (14.4 J/min). b MP referenced to compliance (0.53 J/min/ml/cm H2O) during the first 3 days of ECMO. ECMO, extracorporeal membrane oxygenation; MP, mechanical power
See this image and copyright information in PMC

References

    1. Brodie D, Bacchetta M. Extracorporeal membrane oxygenation for ARDS in adults. N Engl J Med. 2011;365:1905–1914. doi: 10.1056/NEJMct1103720. - DOI - PubMed
    1. Abrams D, Schmidt M, Pham T, Beitler JR, Fan E, Goligher EC, et al. Mechanical ventilation for acute respiratory distress syndrome during extracorporeal life support. Research and practice. Am J Respir Crit Care Med. 2020;201:514–525. doi: 10.1164/rccm.201907-1283CI. - DOI - PubMed
    1. Cressoni M, Gotti M, Chiurazzi C, Massari D, Algieri I, Amini M, et al. Mechanical power and development of ventilator-induced lung injury. Anesthesiology. 2016;124:1100–1108. doi: 10.1097/ALN.0000000000001056. - DOI - PubMed
    1. Gattinoni L, Tonetti T, Cressoni M, Cadringher P, Herrmann P, Moerer O, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med. 2016;42:1567–1575. doi: 10.1007/s00134-016-4505-2. - DOI - PubMed
    1. Gattinoni L, Tonetti T, Quintel M. Intensive care medicine in 2050: ventilator-induced lung injury. Intensive Care Med. 2018;44:76–78. doi: 10.1007/s00134-017-4770-8. - DOI - PubMed

Publication types

LinkOut - more resources