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. 2023 Sep 20:36:11506.
doi: 10.3389/ti.2023.11506. eCollection 2023.

Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation

Alessandro Ghiani  1 , Nikolaus Kneidinger  2   3 , Claus Neurohr  1   3 , Sandra Frank  4 , Ludwig Christian Hinske  4   5 , Christian Schneider  3   6 , Sebastian Michel  3   7 , Michael Irlbeck  4
Affiliations

Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation

Alessandro Ghiani et al. Transpl Int. .

Abstract

Prolonged mechanical ventilation (PMV) after lung transplantation poses several risks, including higher tracheostomy rates and increased in-hospital mortality. Mechanical power (MP) of artificial ventilation unifies the ventilatory variables that determine gas exchange and may be related to allograft function following transplant, affecting ventilator weaning. We retrospectively analyzed consecutive double lung transplant recipients at a national transplant center, ventilated through endotracheal tubes upon ICU admission, excluding those receiving extracorporeal support. MP and derived indexes assessed up to 36 h after transplant were correlated with invasive ventilation duration using Spearman's coefficient, and we conducted receiver operating characteristic (ROC) curve analysis to evaluate the accuracy in predicting PMV (>72 h), expressed as area under the ROC curve (AUROC). PMV occurred in 82 (35%) out of 237 cases. MP was significantly correlated with invasive ventilation duration (Spearman's ρ = 0.252 [95% CI 0.129-0.369], p < 0.01), with power density (MP normalized to lung-thorax compliance) demonstrating the strongest correlation (ρ = 0.452 [0.345-0.548], p < 0.01) and enhancing PMV prediction (AUROC 0.78 [95% CI 0.72-0.83], p < 0.01) compared to MP (AUROC 0.66 [0.60-0.72], p < 0.01). Mechanical power density may help identify patients at risk for PMV after double lung transplantation.

Keywords: extubation; lung transplantation; mechanical power; prolonged ventilation; ventilator weaning.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Patient flow diagram. Legend: Abbreviations. ECMO, extracorporeal membrane oxygenation; PMV, prolonged mechanical ventilation (>72 h).
FIGURE 2
FIGURE 2
Between-group differences in trajectories of ventilatory indexes. Legend: Dynamic lung-thorax compliance, mechanical power, and power density are compared between PMV and non-PMV subjects according to the median of parameters within time quartiles collected following transplantation. Abbreviations: PBW-MP, mechanical power normalized to the predicted body weight; LTCdyn-MP, mechanical power normalized to dynamic lung-thorax compliance; PMV, prolonged mechanical ventilation.
FIGURE 3
FIGURE 3
Correlations between ventilatory indexes and invasive ventilation duration. Legend: The heat map of Spearman’s correlation coefficients (ρ) with the LOESS (Local Regression Smoothing) trendline. The Y and X-axes have logarithmic scales. Abbreviations: ρ, Spearman’s correlation coefficient (with 95% confidence interval); PBW-MP, mechanical power normalized to the predicted body weight; LTCdyn-MP, mechanical power normalized to dynamic lung-thorax compliance.
FIGURE 4
FIGURE 4
ROC curves for the ventilatory indexes predicting post-transplant prolonged mechanical ventilation. Legend: The accuracy of each index in predicting prolonged mechanical ventilation (>72 h) is presented as the area under the receiver operating characteristic (ROC) curve with 95% confidence intervals. Abbreviations: AUROC, area under the receiver operating characteristic curve; PBW-MP, mechanical power normalized to the predicted body weight; LTCdyn-MP, mechanical power normalized to dynamic lung-thorax compliance.
See this image and copyright information in PMC

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