Understanding ventilator-induced lung injury: The role of mechanical power

Stephan von Düring¹, Ken Kuljit S Parhar², Neill K J Adhikari³, Martin Urner⁴, S Joseph Kim⁵, Laveena Munshi⁶, Kuan Liu⁷, Eddy Fan⁸

Affiliations

¹ Division of Critical Care Medicine, Department of Acute Medicine, Geneva University Hospitals (HUG) and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. Electronic address: Stephan.vonDuring@hug.ch.
² Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada. Electronic address: ken.parhar@albertahealthservices.ca.
³ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. Electronic address: neill.adhikari@sunnybrook.ca.
⁴ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesiology & Pain Medicine, University of Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada. Electronic address: Martin.Urner@uhn.ca.
⁵ Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Nephrology, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. Electronic address: Joseph.Kim@uhn.ca.
⁶ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. Electronic address: Laveena.Munshi@sinaihealth.ca.
⁷ Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. Electronic address: kuan.liu@utoronto.ca.
⁸ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada; Division of Respirology, Department of Medicine, University Health Network, Toronto, ON, Canada. Electronic address: eddy.fan@uhn.ca.

PMID: 39241350
DOI: 10.1016/j.jcrc.2024.154902

Free article

Review

Understanding ventilator-induced lung injury: The role of mechanical power

Stephan von Düring et al. J Crit Care. 2025 Feb.

Free article

. 2025 Feb:85:154902.

doi: 10.1016/j.jcrc.2024.154902. Epub 2024 Sep 5.

Authors

Stephan von Düring¹, Ken Kuljit S Parhar², Neill K J Adhikari³, Martin Urner⁴, S Joseph Kim⁵, Laveena Munshi⁶, Kuan Liu⁷, Eddy Fan⁸

Affiliations

¹ Division of Critical Care Medicine, Department of Acute Medicine, Geneva University Hospitals (HUG) and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. Electronic address: Stephan.vonDuring@hug.ch.
² Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada. Electronic address: ken.parhar@albertahealthservices.ca.
³ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. Electronic address: neill.adhikari@sunnybrook.ca.
⁴ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesiology & Pain Medicine, University of Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada. Electronic address: Martin.Urner@uhn.ca.
⁵ Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Nephrology, University Health Network, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. Electronic address: Joseph.Kim@uhn.ca.
⁶ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. Electronic address: Laveena.Munshi@sinaihealth.ca.
⁷ Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada. Electronic address: kuan.liu@utoronto.ca.
⁸ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada; Division of Respirology, Department of Medicine, University Health Network, Toronto, ON, Canada. Electronic address: eddy.fan@uhn.ca.

PMID: 39241350
DOI: 10.1016/j.jcrc.2024.154902

Abstract

Mechanical ventilation stands as a life-saving intervention in the management of respiratory failure. However, it carries the risk of ventilator-induced lung injury. Despite the adoption of lung-protective ventilation strategies, including lower tidal volumes and pressure limitations, mortality rates remain high, leaving room for innovative approaches. The concept of mechanical power has emerged as a comprehensive metric encompassing key ventilator parameters associated with the genesis of ventilator-induced lung injury, including volume, pressure, flow, resistance, and respiratory rate. While numerous animal and human studies have linked mechanical power and ventilator-induced lung injury, its practical implementation at the bedside is hindered by calculation challenges, lack of equation consensus, and the absence of an optimal threshold. To overcome the constraints of measuring static respiratory parameters, dynamic mechanical power is proposed for all patients, regardless of their ventilation mode. However, establishing a causal relationship is crucial for its potential implementation, and requires further research. The objective of this review is to explore the role of mechanical power in ventilator-induced lung injury, its association with patient outcomes, and the challenges and potential benefits of implementing a ventilation strategy based on mechanical power.

Keywords: Positive-pressure respiration; Pulmonary ventilation; Respiratory distress syndrome; Respiratory insufficiency; Ventilator-induced lung injury.

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Conflict of interest statement

Declaration of competing interest SvD has received speaking honoraria from Löwenstein Medical. SJK is a member of the Data Monitoring Committee for a clinical trial sponsored by Eledon Pharmaceuticals testing a novel therapeutic in kidney transplantation. EF reports personal fees from ALung Technologies, Baxter, Getinge, Inspira, Vasomune, and Zoll Medical outside the submitted work.

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Understanding ventilator-induced lung injury: The role of mechanical power

Affiliations

Understanding ventilator-induced lung injury: The role of mechanical power

Authors

Affiliations

Abstract

Conflict of interest statement

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