Mechanical power at a glance: a simple surrogate for volume-controlled ventilation

Intensive Care Medicine Experimental - 2019
Lorenzo Giosa1, Mattia Busana1, Iacopo Pasticci1, Matteo Bonifazi1, Matteo Maria Macrì1, Federica Romitti1, Francesco Vassalli1, Davide Chiumello2, Michael Quintel1, John J. Marini3, Luciano Gattinoni1
1Departement of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
2SC Anestesia e Rianimazione, Ospedale San Paolo – Polo Universitario, ASST Santi Paolo e Carlo, Milan, Italy
3University of Minnesota and Regions Hospital, Minneapolis/St. Paul, MN, USA

Tóm tắt

AbstractBackgroundMechanical power is a summary variable including all the components which can possibly cause VILI (pressures, volume, flow, respiratory rate). Since the complexity of its mathematical computation is one of the major factors that delay its clinical use, we propose here a simple and easy to remember equation to estimate mechanical power under volume-controlled ventilation:$$ \mathrm{Mechanical}\ \mathrm{Power}=\frac{\mathrm{VE}\times \left(\mathrm{Peak}\ \mathrm{Pressure}+\mathrm{PEEP}+F/6\right)}{20} $$Mechanical Power=VE×Peak Pressure+PEEP+F/620where the mechanical power is expressed in Joules/minute, the minute ventilation (VE) in liters/minute, the inspiratory flow (F) in liters/minute, and peak pressure and positive end-expiratory pressure (PEEP) in centimeter of water. All the components of this equation are continuously displayed by any ventilator under volume-controlled ventilation without the need for clinician intervention.To test the accuracy of this new equation, we compared it with the reference formula of mechanical power that we proposed for volume-controlled ventilation in the past. The comparisons were made in a cohort of mechanically ventilated pigs (485 observations) and in a cohort of ICU patients (265 observations).ResultsBoth in pigs and in ICU patients, the correlation between our equation and the reference one was close to the identity. Indeed, theR2ranged from 0.97 to 0.99 and the Bland-Altman showed small biases (ranging from + 0.35 to − 0.53 J/min) and proportional errors (ranging from + 0.02 to − 0.05).ConclusionsOur new equation of mechanical power for volume-controlled ventilation represents a simple and accurate alternative to the more complex ones available to date. This equation does not need any clinical intervention on the ventilator (such as an inspiratory hold) and could be easily implemented in the software of any ventilator in volume-controlled mode. This would allow the clinician to have an estimation of mechanical power at a simple glance and thus increase the clinical consciousness of this variable which is still far from being used at the bedside. Our equation carries the same limitations of all other formulas of mechanical power, the most important of which, as far as it concerns VILI prevention, are the lack of normalization and its application to the whole respiratory system (including the chest wall) and not only to the lung parenchyma.

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