The Association Between Mechanical Power Within the First 24 Hours and ICU Mortality in Mechanically Ventilated Adult Patients With Acute Hypoxemic Respiratory Failure
Bibliographic record
Abstract
BACKGROUND: Despite the widespread adoption of lung-protective ventilation strategies, mortality among patients receiving invasive mechanical ventilation (IMV) remains high. Mechanical power (MP) integrates various variables responsible for ventilator-induced lung injury and has been associated with mortality in patients with ARDS. However, the impact of MP on ICU mortality in the larger group of patients with acute hypoxemic respiratory failure (AHRF) has not been well established, and previous studies have reported inconsistent thresholds for predicting outcomes. RESEARCH QUESTION: Is high MP (> 17 J/min) within the first 24 hours of IMV, calculated using dynamic driving pressure, associated with ICU mortality in patients with AHRF? Additionally, does a threshold exist below which IMV is considered safe? STUDY DESIGN AND METHODS: In this multicenter cohort study, we included adult patients with AHRF who received IMV. Patients were excluded if they received IMV for > 24 hours before inclusion or were receiving extracorporeal life support. We applied multivariable logistic regression models with inverse probability of treatment weighting and used change-point regression models with restricted cubic splines. RESULTS: Of the 21,714 patients in our registry, 9,031 patients (42%) met the inclusion criteria. After adjusting for baseline characteristics, high MP was associated with increased ICU mortality (OR, 1.58; 95% CI, 1.44-1.72), with a nonlinear dose-response relationship. No consistent safe MP threshold was identified. High MP also was associated with lower extubation rates and fewer ventilator-free days. INTERPRETATION: In this study, exposure to high MP within the first 24 hours of IMV was associated with increased ICU mortality in patients with AHRF. The absence of a consistent safe threshold suggests that reducing MP at IMV initiation may be a strategy to improve outcomes, warranting exploration in clinical trials.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".