ArticleThe Lancet. Respiratory medicine2020
Time-varying intensity of mechanical ventilation and mortality in patients with acute respiratory failure: a registry-based, prospective cohort study.
Article in The Lancet. Respiratory medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 102 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Mechanical Power Normalized to Compliance in Patients With Acute Respiratory Distress Syndrome
Risk Factors for Prolonged Mechanical Ventilation in Elevated Mean Airway Pressure Based on a Remote Ventilation Monitoring Platform
Biphasic Positive Airway Pressure Ventilation Versus Flow-Controlled Ventilation in Burn Patients: A Monocentric, Randomized Controlled, Parallel Group Trial
Who cites it
102 citing papers in PubMed, 2 syntheses or guidelines pooled it, 213 citations in OpenAlex.
- The Association Between Mechanical Power and Mortality in Critically Ill Patients Receiving Invasive Mechanical Ventilation: A Systematic Review and Meta-Analysis.Critical care medicine · 2026Pooled it
- Electrical impedance tomography-guided positive end-expiratory pressure titration in ARDS: a systematic review and meta-analysis.Intensive care medicine · 2024Pooled it
- Elastance May Determine the Neuromuscular Blockade Effect on Mortality in Acute Respiratory Distress Syndrome.American journal of respiratory and critical care medicine · 2025Trial
- Association between urea trajectory and protein dose in critically ill adults: a secondary exploratory analysis of the effort protein trial (RE-EFFORT).Critical care (London, England) · 2024Trial
- Effect of automated versus conventional ventilation on mechanical power of ventilation-A randomized crossover clinical trial.PloS one · 2024Trial
- Development and validation of VentPilot: an AI-based recommendation system for mechanical ventilation.Journal of intensive care · 2026Article
- Effects of PERMISSive lung-protective ventilation on outcome in critically ill, invasively ventilated patients (PERMISS): protocol for a feasibility and safety randomised clinical trial.BMJ open respiratory research · 2026Article
- Characterization and 3-Year Survival of Clinical Subtypes and Host Response Phenotypes of Acute Respiratory Failure Requiring Mechanical Ventilation.CHEST critical care · 2026Article
- ARDS management beyond the guidelines: a practical physiology-based approach to individualized care.Intensive care medicine · 2026Review
- Discrepancies between estimated and geometrically derived mechanical power in invasively ventilated patients - insights from a randomized clinical trial.Intensive care medicine experimental · 2026Article
- Power, Duration, and Compliance: Reframing Risk of Ventilatory-Induced Lung Injury With the Risk-Adjusted Mechanical-Power Score.Critical care medicine · 2026Article
- Targeting driving pressure in ARDS: refining the "When" and "How" after the STAMINA trial.Journal of thoracic disease · 2026Article
- Setting mechanical ventilation in patients with acute brain injury: ultra-low dynamic driving pressure for better outcomes?Intensive care medicine · 2026Article
- Validation of the Formulas for Mechanical Power in Children and Proposal of the Concept of "Effective Mechanical Power".Journal of clinical medicine · 2026Article
- Dynamic driving pressure and clinical outcomes in mechanically ventilated patients with acute brain injury: a secondary analysis of the VENTIBRAIN studyIntensive care medicine · 2026Observational
- Ventilator-induced lung injury: from mechanisms to integrated clinical management.Frontiers in medicine · 2026Review
- Take a deep breath: managing the challenges of acute respiratory distress syndrome cases.Trauma surgery & acute care open · 2026Review
- Article
- Effects of two mechanical ventilation strategies during cardiopulmonary bypass on perioperative mechanical power: a prospective observational study.Frontiers in cardiovascular medicine · 2026Article
- Time to death and its predictors among adults on mechanical ventilation at Hiwot Fana comprehensive specialized hospital, eastern Ethiopia: A retrospective cohort study.SAGE open medicine · 2026Article
42 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
Background Mortality in acute respiratory failure remains high despite the use of lung-protective ventilation. Recent studies have shown an association between baseline ventilation parameters (driving pressure or mechanical power) and outcomes for patients with acute respiratory distress syndrome. Strategies focused on limiting these parameters have been proposed to further improve outcomes. However, it remains unknown whether driving pressure and mechanical power should be limited over the entire duration of mechanical ventilation and in all patients with acute respiratory failure. We aimed to estimate the association between exposure to different intensities of mechanical ventilation over time and intensive care unit (ICU) mortality in patients with acute respiratory failure.
methodsIn this registry-based, prospective cohort study, we obtained data from the Toronto Intensive Care Observational Registry, which includes all patients receiving mechanical ventilation for 4 h or more in nine ICUs that are affiliated with the University of Toronto (Toronto, ON, Canada). We included all adult (≥18 years) patients who received invasive mechanical ventilation between April 11, 2014, and June 5, 2019. Patients were excluded if they received treatment with extracorporeal life support. The primary outcome was ICU mortality. Bayesian joint models were used to estimate the strength of associations, accounting for informative censoring due to death during follow-up.
findingsOf 13 939 patients recorded in the registry, 13 408 (96·2%) were eligible for descriptive analysis. The primary analysis comprised 7876 (58·7%) patients with complete baseline characteristics, and a secondary analysis included all 13 408 patients after multiple imputation in the joint model analysis. 2409 (18·0%) of 13 408 patients died in the ICU. After adjustment for baseline characteristics, including age and severity of illness, a significant increase in the hazard of death was found to be associated with each daily increment in driving pressure (hazard ratio 1·064, 95% credible interval 1·057-1·071) or mechanical power (hazard ratio 1·060, 95% credible interval 1·053-1·066). These associations persisted over the duration of mechanical ventilation.
interpretationCumulative exposure to higher intensities of mechanical ventilation was harmful, even for short durations. Limiting exposure to driving pressure or mechanical power should be evaluated in further studies as promising ventilation strategies to reduce mortality in patients with acute respiratory failure.
fundingCanadian Institutes of Health Research.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.