Mechanical power is not associated with mortality in COVID-19 mechanically ventilated patients

CIBERESUCICOVID Project investigators (COV20/00110, ISCIII)

doi:10.1186/s13613-025-01430-6

Mechanical power is not associated with mortality in COVID-19 mechanically ventilated patients

CIBERESUCICOVID Project investigators (COV20/00110, ISCIII)

Visual and Multimodal Interaction

Azienda Sanitaria Ulss 6 Vicenza
University of Milan
Hospital Sagrat Cor de Barcelona
Vall d'Hebron Research Institute
Hospital Universitario de Getafe
Universidad Autónoma de Madrid
Hospital Universitario San Agustín
Hospital Universitario HM Montepríncipe
Hospital del Ramon y Cajal
University of Alcalá
Hospital Clínico Universitario de Valladolid
Hospital Alvaro Cunqueiro
Hospital Clinico Universitario de Valencia
Hospital de Mostoles
Complejo Hospitalario Universitario de Santiago
University of Cádiz
Hospital Universitario San Pedro de Alcántara
Pulmonary and Critical Care Division
Hospital Nuestra Señora de Gracia
Hospital Universitario de Valme
Del Mar University Hospital
Francisco de Vitoria University
Hospital Universitario Infanta Leonor
Hospital Universitario Río Carrión
University of Oviedo
Hospital General de Segovia
Hospital Son Dureta
Hospital Universitari Principe de Asturias
Hospital Universitario Sant Joan d'Alacant
Hospital Universitario La Fe
Hospital Universitario Son Llàtzer
Hospital de Gran Canaria Dr. Negrin
Hospital Universitario Río Hortega
Hospital Punta de Europa
Hospital Universitario de León
Complexo Hospitalario Universitario de Ourense

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Abstract

Background: The relative contribution of the different components of mechanical power to mortality is a subject of debate and has not been studied in COVID-19. The aim of this study is to evaluate both the total and the relative impact of each of the components of mechanical power on mortality in a well-characterized cohort of patients with COVID-19-induced acute respiratory failure undergoing invasive mechanical ventilation. This is a secondary analysis of the CIBERESUCICOVID project, a multicenter observational cohort study including fifty Spanish intensive care units that included COVID-19 mechanically ventilated patients between February 2020 and December 2021. We examined the association between mechanical power and its components (elastic static, elastic dynamic, total elastic and resistive power) with 90-day mortality after adjusting for confounders in seven hundred ninety-nine patients with COVID-19-induced respiratory failure undergoing invasive mechanical ventilation. Results: At the initiation of mechanical ventilation, the PaO₂/FiO₂ ratio was 106 (78; 150), ventilatory ratio was 1.69 (1.40; 2.05), and respiratory system compliance was 35.7 (29.2; 44.5) ml/cmH₂O. Mechanical power at the initiation of mechanical ventilation was 24.3 (18.9; 29.6) J/min, showing no significant changes after three days. In multivariable regression analyses, mechanical power and its components were not associated with 90-day mortality at the start of mechanical ventilation. After three days, total elastic and elastic static power were associated with higher 90-day mortality, but this relationship was also found for positive end-expiratory pressure. Conclusions: Neither mechanical power nor its components were independently associated with mortality in COVID-19-induced acute respiratory failure at the start of MV. Nevertheless, after three days, static elastic power and total elastic power were associated with lower odds of survival. Positive end-expiratory pressure and plateau pressure, however, captured this risk in a similar manner.

Original language	English
Article number	27
Journal	Annals of Intensive Care
Volume	15
Issue number	1
DOIs	https://doi.org/10.1186/s13613-025-01430-6
Publication status	Published - Dec 2025

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

COVID-19
Mechanical power
Mechanical ventilation
Respiratory failure

Access to Document

10.1186/s13613-025-01430-6

Mechanical power is not associatedFinal published version, 898 KBLicence: CC BY

Cite this

@article{2234b450a5d74416bc2e57e4426bc83c,

title = "Mechanical power is not associated with mortality in COVID-19 mechanically ventilated patients",

abstract = "Background: The relative contribution of the different components of mechanical power to mortality is a subject of debate and has not been studied in COVID-19. The aim of this study is to evaluate both the total and the relative impact of each of the components of mechanical power on mortality in a well-characterized cohort of patients with COVID-19-induced acute respiratory failure undergoing invasive mechanical ventilation. This is a secondary analysis of the CIBERESUCICOVID project, a multicenter observational cohort study including fifty Spanish intensive care units that included COVID-19 mechanically ventilated patients between February 2020 and December 2021. We examined the association between mechanical power and its components (elastic static, elastic dynamic, total elastic and resistive power) with 90-day mortality after adjusting for confounders in seven hundred ninety-nine patients with COVID-19-induced respiratory failure undergoing invasive mechanical ventilation. Results: At the initiation of mechanical ventilation, the PaO2/FiO2 ratio was 106 (78; 150), ventilatory ratio was 1.69 (1.40; 2.05), and respiratory system compliance was 35.7 (29.2; 44.5) ml/cmH2O. Mechanical power at the initiation of mechanical ventilation was 24.3 (18.9; 29.6) J/min, showing no significant changes after three days. In multivariable regression analyses, mechanical power and its components were not associated with 90-day mortality at the start of mechanical ventilation. After three days, total elastic and elastic static power were associated with higher 90-day mortality, but this relationship was also found for positive end-expiratory pressure. Conclusions: Neither mechanical power nor its components were independently associated with mortality in COVID-19-induced acute respiratory failure at the start of MV. Nevertheless, after three days, static elastic power and total elastic power were associated with lower odds of survival. Positive end-expiratory pressure and plateau pressure, however, captured this risk in a similar manner.",

keywords = "COVID-19, Mechanical power, Mechanical ventilation, Respiratory failure",

author = "\{CIBERESUCICOVID Project investigators (COV20/00110, ISCIII)\} and Enric Barbeta and Cl{\'a}udia Barreiros and Edoardo Forin and Amedeo Guzzardella and Anna Motos and Laia Fern{\'a}ndez-Barat and Albert Gabarr{\'u}s and Adri{\'a}n Ceccato and Ricard Ferrer and Jordi Riera and Oscar Pe{\~n}uelas and Lorente, \{Jos{\'e} {\'A}ngel\} and \{de Gonzalo-Calvo\}, David and Jessica Gonzalez and Rosario Amaya-Villar and A{\~n}{\'o}n, \{Jos{\'e} Manuel\} and Ana Balan and Carme Barber{\`a} and Jos{\'e} Barber{\'a}n and Aaron Blandino and Boado, \{Maria Victoria\} and Elena Bustamante-Munguira and Jes{\'u}s Caballero and Cant{\'o}n-Bulnes, \{Mar{\'i}a Luisa\} and Cristina Carbajales and Nieves Carbonell and Mercedes Catal{\'a}n-Gonz{\'a}lez and Nieves Franco and Crist{\'o}bal Galb{\'a}n and Gumucio-Sanguino, \{V{\'i}ctor D.\} and \{de la Torre\}, \{Maria Del Carmen\} and Emilio D{\'i}az and {\'A}ngel Estella and Elena Gallego and G{\'o}mez, \{Jos{\'e} Manuel\} and Arturo Huerta and Garc{\'i}a, \{Ruth Noem{\'i} Jorge\} and Ana Loza-V{\'a}zquez and Judith Marin-Corral and Delgado, \{Mar{\'i}a Cruz Martin\} and Amalia Mart{\'i}nez and Ignacio Mart{\'i}nez and Juan Lopez and Albaiceta, \{Guillermo M.\} and Nieto, \{Mar{\'i}a Teresa\} and Novo, \{Mariana Andrea\} and Yhivian Pe{\~n}asco and Felipe P{\'e}rez-Garc{\'i}a and Pilar Ricart and Bastida, \{Leire P{\'e}rez\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

month = dec,

doi = "10.1186/s13613-025-01430-6",

language = "English",

volume = "15",

journal = "Annals of Intensive Care",

issn = "2110-5820",

publisher = "Springer-Verlag GmbH and Co. KG",

number = "1",

}

TY - JOUR

T1 - Mechanical power is not associated with mortality in COVID-19 mechanically ventilated patients

AU - CIBERESUCICOVID Project investigators (COV20/00110, ISCIII)

AU - Barbeta, Enric

AU - Barreiros, Cláudia

AU - Forin, Edoardo

AU - Guzzardella, Amedeo

AU - Motos, Anna

AU - Fernández-Barat, Laia

AU - Gabarrús, Albert

AU - Ceccato, Adrián

AU - Ferrer, Ricard

AU - Riera, Jordi

AU - Peñuelas, Oscar

AU - Lorente, José Ángel

AU - de Gonzalo-Calvo, David

AU - Gonzalez, Jessica

AU - Amaya-Villar, Rosario

AU - Añón, José Manuel

AU - Balan, Ana

AU - Barberà, Carme

AU - Barberán, José

AU - Blandino, Aaron

AU - Boado, Maria Victoria

AU - Bustamante-Munguira, Elena

AU - Caballero, Jesús

AU - Cantón-Bulnes, María Luisa

AU - Carbajales, Cristina

AU - Carbonell, Nieves

AU - Catalán-González, Mercedes

AU - Franco, Nieves

AU - Galbán, Cristóbal

AU - Gumucio-Sanguino, Víctor D.

AU - de la Torre, Maria Del Carmen

AU - Díaz, Emilio

AU - Estella, Ángel

AU - Gallego, Elena

AU - Gómez, José Manuel

AU - Huerta, Arturo

AU - García, Ruth Noemí Jorge

AU - Loza-Vázquez, Ana

AU - Marin-Corral, Judith

AU - Delgado, María Cruz Martin

AU - Martínez, Amalia

AU - Martínez, Ignacio

AU - Lopez, Juan

AU - Albaiceta, Guillermo M.

AU - Nieto, María Teresa

AU - Novo, Mariana Andrea

AU - Peñasco, Yhivian

AU - Pérez-García, Felipe

AU - Ricart, Pilar

AU - Bastida, Leire Pérez

PY - 2025/12

Y1 - 2025/12

N2 - Background: The relative contribution of the different components of mechanical power to mortality is a subject of debate and has not been studied in COVID-19. The aim of this study is to evaluate both the total and the relative impact of each of the components of mechanical power on mortality in a well-characterized cohort of patients with COVID-19-induced acute respiratory failure undergoing invasive mechanical ventilation. This is a secondary analysis of the CIBERESUCICOVID project, a multicenter observational cohort study including fifty Spanish intensive care units that included COVID-19 mechanically ventilated patients between February 2020 and December 2021. We examined the association between mechanical power and its components (elastic static, elastic dynamic, total elastic and resistive power) with 90-day mortality after adjusting for confounders in seven hundred ninety-nine patients with COVID-19-induced respiratory failure undergoing invasive mechanical ventilation. Results: At the initiation of mechanical ventilation, the PaO2/FiO2 ratio was 106 (78; 150), ventilatory ratio was 1.69 (1.40; 2.05), and respiratory system compliance was 35.7 (29.2; 44.5) ml/cmH2O. Mechanical power at the initiation of mechanical ventilation was 24.3 (18.9; 29.6) J/min, showing no significant changes after three days. In multivariable regression analyses, mechanical power and its components were not associated with 90-day mortality at the start of mechanical ventilation. After three days, total elastic and elastic static power were associated with higher 90-day mortality, but this relationship was also found for positive end-expiratory pressure. Conclusions: Neither mechanical power nor its components were independently associated with mortality in COVID-19-induced acute respiratory failure at the start of MV. Nevertheless, after three days, static elastic power and total elastic power were associated with lower odds of survival. Positive end-expiratory pressure and plateau pressure, however, captured this risk in a similar manner.

AB - Background: The relative contribution of the different components of mechanical power to mortality is a subject of debate and has not been studied in COVID-19. The aim of this study is to evaluate both the total and the relative impact of each of the components of mechanical power on mortality in a well-characterized cohort of patients with COVID-19-induced acute respiratory failure undergoing invasive mechanical ventilation. This is a secondary analysis of the CIBERESUCICOVID project, a multicenter observational cohort study including fifty Spanish intensive care units that included COVID-19 mechanically ventilated patients between February 2020 and December 2021. We examined the association between mechanical power and its components (elastic static, elastic dynamic, total elastic and resistive power) with 90-day mortality after adjusting for confounders in seven hundred ninety-nine patients with COVID-19-induced respiratory failure undergoing invasive mechanical ventilation. Results: At the initiation of mechanical ventilation, the PaO2/FiO2 ratio was 106 (78; 150), ventilatory ratio was 1.69 (1.40; 2.05), and respiratory system compliance was 35.7 (29.2; 44.5) ml/cmH2O. Mechanical power at the initiation of mechanical ventilation was 24.3 (18.9; 29.6) J/min, showing no significant changes after three days. In multivariable regression analyses, mechanical power and its components were not associated with 90-day mortality at the start of mechanical ventilation. After three days, total elastic and elastic static power were associated with higher 90-day mortality, but this relationship was also found for positive end-expiratory pressure. Conclusions: Neither mechanical power nor its components were independently associated with mortality in COVID-19-induced acute respiratory failure at the start of MV. Nevertheless, after three days, static elastic power and total elastic power were associated with lower odds of survival. Positive end-expiratory pressure and plateau pressure, however, captured this risk in a similar manner.

KW - COVID-19

KW - Mechanical power

KW - Mechanical ventilation

KW - Respiratory failure

UR - https://www.scopus.com/pages/publications/86000671916

U2 - 10.1186/s13613-025-01430-6

DO - 10.1186/s13613-025-01430-6

M3 - Article

AN - SCOPUS:86000671916

SN - 2110-5820

VL - 15

JO - Annals of Intensive Care

JF - Annals of Intensive Care

IS - 1

M1 - 27

ER -

Mechanical power is not associated with mortality in COVID-19 mechanically ventilated patients

Abstract

UN SDGs

Keywords

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