Association Between Mechanical Power During Prone Positioning and Mortality in Patients With Acute Respiratory Distress Syndrome

Collaborators, Affiliations

Collaborators

China Critical Care Clinical Trials Group (CCCCTG):
Ming-Yan Zhao⁵, Song-Lin Yang⁵, Xiao-Chun Ma⁶, Yi-Ni Sun⁶, Yong-Jie Yin⁶, De-Xin Liu⁷, Zhen-Jie Hu⁸, Yan Huo⁸, Li Jiang⁹, Qi Zhang⁹, You-Zhong An¹⁰, Hui-Ying Zhao¹⁰, Tong Li¹¹, Wei He¹¹, Da-Wei Wu¹², Chen Li¹², En-Qiang Mao¹³, Cheng Zhu¹³, Tie-He Qin¹⁴, Shou-Hong Wang¹⁴, Rongqing Sun¹⁵, Yue-Xia Li¹⁵, Yu-Hang Ai¹⁶, Yin Huang¹⁶, Jian- Dong Lin¹⁷, Xiong-Jian Xiao¹⁷, Zhen-Yang He¹⁸, Rui Li¹⁸, Yan Kang¹⁸, Xue-Lian Liao¹⁹, Shu-Sheng Li²⁰, Xiao Ran²⁰, Xiang-You Yu²¹, Yi Wang²¹, Li-Hua Zhou²², Li-Peng Zhang²², Xi-Jing Zhang²³, Bin-Xiao Su²³, Fa-Chun Zhou²⁴, Fang Xu²⁴, Ren-Hua Su²⁵, Qian Li²⁵, Chuan-Yun Qian²⁶, Wei Zhang²⁶, Xiang-Yuan Cao²⁷, Xi-Gang Ma²⁷, Qing-Yuan Zhan²⁸, Xu Huang²⁸, Ming Hou²⁹, Bin Du³⁰, Li Weng³⁰, Xiao-Yun Hu³⁰

Affiliations

¹ Department of Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
² Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
³ Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
⁴ RocketMedical Co., Ltd. Beijing, China.
⁵ Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
⁶ Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
⁷ Department of Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China.
⁸ Department of Critical Care Medicine, Hebei Medical University Fourth Hospital, Shijiazhuang, China.
⁹ Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China.
¹⁰ Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China.
¹¹ Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
¹² Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China.
¹³ Emergency Intensive Care Unit, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China.
¹⁴ Department of Critical Care Medicine, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong, China.
¹⁵ Surgical Intensive Care Unit, The First Affiliated Hospital, Zhengzhou University, Henan, China.
¹⁶ Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China.
¹⁷ Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fujian, China.
¹⁸ Department of Critical Care Medicine, Hainan Provincial People's Hospital, Hainan, China.
¹⁹ Department of Critical Care Medicine, West China Hospital, Sichuan University, Sichuan, China.
²⁰ Department of Critical Care Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
²¹ Department of Critical Care Medicine, First Affiliated Hospital, Xinjiang Medical University, Xinjiang, China.
²² Department of Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China.
²³ Surgical Intensive Care Unit, Xijing Hospital, Fourth Military Medical University, Xian, China.
²⁴ Department of Emergency and Intensive Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
²⁵ Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Zhejiang, China.
²⁶ Department of Emergency Medicine and Emergency/Medical ICU, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
²⁷ Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Ningxia, China.
²⁸ Medical Intensive Care Unit, Department of Pulmonology, China-Japan Friendship Hospital, Beijing, China.
²⁹ Emergency Intensive Care Unit, Qinghai University Affiliated Hospital, Qinghai, China.
³⁰ Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China.

PMID: 40742232
DOI: 10.1097/CCM.0000000000006811

Association Between Mechanical Power During Prone Positioning and Mortality in Patients With Acute Respiratory Distress Syndrome

Yao Wu et al. Crit Care Med. 2025.

. 2025 Jul 31.

doi: 10.1097/CCM.0000000000006811. Online ahead of print.

Authors

Collaborators

China Critical Care Clinical Trials Group (CCCCTG):
Ming-Yan Zhao⁵, Song-Lin Yang⁵, Xiao-Chun Ma⁶, Yi-Ni Sun⁶, Yong-Jie Yin⁶, De-Xin Liu⁷, Zhen-Jie Hu⁸, Yan Huo⁸, Li Jiang⁹, Qi Zhang⁹, You-Zhong An¹⁰, Hui-Ying Zhao¹⁰, Tong Li¹¹, Wei He¹¹, Da-Wei Wu¹², Chen Li¹², En-Qiang Mao¹³, Cheng Zhu¹³, Tie-He Qin¹⁴, Shou-Hong Wang¹⁴, Rongqing Sun¹⁵, Yue-Xia Li¹⁵, Yu-Hang Ai¹⁶, Yin Huang¹⁶, Jian- Dong Lin¹⁷, Xiong-Jian Xiao¹⁷, Zhen-Yang He¹⁸, Rui Li¹⁸, Yan Kang¹⁸, Xue-Lian Liao¹⁹, Shu-Sheng Li²⁰, Xiao Ran²⁰, Xiang-You Yu²¹, Yi Wang²¹, Li-Hua Zhou²², Li-Peng Zhang²², Xi-Jing Zhang²³, Bin-Xiao Su²³, Fa-Chun Zhou²⁴, Fang Xu²⁴, Ren-Hua Su²⁵, Qian Li²⁵, Chuan-Yun Qian²⁶, Wei Zhang²⁶, Xiang-Yuan Cao²⁷, Xi-Gang Ma²⁷, Qing-Yuan Zhan²⁸, Xu Huang²⁸, Ming Hou²⁹, Bin Du³⁰, Li Weng³⁰, Xiao-Yun Hu³⁰

Affiliations

¹ Department of Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
² Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
³ Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
⁴ RocketMedical Co., Ltd. Beijing, China.
⁵ Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
⁶ Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China.
⁷ Department of Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China.
⁸ Department of Critical Care Medicine, Hebei Medical University Fourth Hospital, Shijiazhuang, China.
⁹ Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing, China.
¹⁰ Department of Critical Care Medicine, Peking University People's Hospital, Beijing, China.
¹¹ Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
¹² Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China.
¹³ Emergency Intensive Care Unit, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China.
¹⁴ Department of Critical Care Medicine, Guangdong Geriatric Institute, Guangdong General Hospital, Guangdong, China.
¹⁵ Surgical Intensive Care Unit, The First Affiliated Hospital, Zhengzhou University, Henan, China.
¹⁶ Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, China.
¹⁷ Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fujian, China.
¹⁸ Department of Critical Care Medicine, Hainan Provincial People's Hospital, Hainan, China.
¹⁹ Department of Critical Care Medicine, West China Hospital, Sichuan University, Sichuan, China.
²⁰ Department of Critical Care Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
²¹ Department of Critical Care Medicine, First Affiliated Hospital, Xinjiang Medical University, Xinjiang, China.
²² Department of Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China.
²³ Surgical Intensive Care Unit, Xijing Hospital, Fourth Military Medical University, Xian, China.
²⁴ Department of Emergency and Intensive Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
²⁵ Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Zhejiang, China.
²⁶ Department of Emergency Medicine and Emergency/Medical ICU, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
²⁷ Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Ningxia, China.
²⁸ Medical Intensive Care Unit, Department of Pulmonology, China-Japan Friendship Hospital, Beijing, China.
²⁹ Emergency Intensive Care Unit, Qinghai University Affiliated Hospital, Qinghai, China.
³⁰ Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China.

PMID: 40742232
DOI: 10.1097/CCM.0000000000006811

Abstract

Objectives: Optimal parameters for evaluating the effectiveness of prone positioning in acute respiratory distress syndrome (ARDS) remain undefined. This study aims to investigate the relationship between dynamic change in mechanical power during prone positioning and mortality in patients with ARDS.

Design: This was a single-center retrospective cohort study.

Setting: The Center of Critical Care Medicine of Peking Union Medical College Hospital.

Patients: ARDS patients who underwent prone positioning while receiving invasive mechanical ventilation were enrolled.

Interventions: None.

Measurements and main results: A total of 1078 patients (720 [66.8%] male; median age, 63 yr [interquartile range (IQR), 51-72 yr]) were enrolled. The median duration of selected prone position sessions was 15.0 hours (IQR, 9.0-17.0 hr). ICU mortality was 20.9% (225/1078). Mechanical power during prone positioning increased in nonsurvivors compared with survivors (0.8 × 10-2 J/min/kg [IQR, -3.3 to 5.6 × 10-2 J/min/kg] vs. -0.6 × 10-2 J/min/kg [IQR, -4.9 to 3.3 × 10-2 J/min/kg]; p = 0.001). Patients with increased mechanical power during prone positioning had higher ICU mortality (23.9% vs. 17.8%; p = 0.011), in-hospital mortality (25.2% vs. 19.5%; p = 0.018), and 28-day mortality (33.2% vs. 25.4%; p = 0.002). Multivariable time-dependent Cox proportional hazards model confirmed that increased mechanical power was independently associated with higher ICU mortality risk (hazard ratio for each 10-U increase in 10-2 J/kg/min 1.071; 95% CI, 1.020-1.125; p = 0.007). Additionally, increased mechanical power during prone positioning was also independently associated with higher in-hospital mortality risk, 28-day mortality risk, and fewer ventilator-free days.

Conclusions: Dynamic increases in mechanical power during prone positioning are linked to higher ICU mortality in ARDS patients. Continuous monitoring of mechanical power may guide patient selection for prone positioning.

Keywords: acute respiratory distress syndrome; mechanical power; prognosis; prone positioning; ventilator-induced lung injury.

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Conflict of interest statement

Dr. C.-Q. Zhu disclosed work for hire. Dr. Weng received support for article research from the Noncommunicable Chronic Diseases-National Science and Technology Major Project (2023ZD0506505), the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2021-I2M-1-062), the National High Level Hospital Clinical Research Funding (2022-PUMCH-D-005, 2022-PUMCH-D-111, 2022-PUMCH-B-126), and the National Health Commission. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

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Association Between Mechanical Power During Prone Positioning and Mortality in Patients With Acute Respiratory Distress Syndrome

Collaborators

Affiliations

Association Between Mechanical Power During Prone Positioning and Mortality in Patients With Acute Respiratory Distress Syndrome

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

Grants and funding

LinkOut - more resources

Full Text Sources