Evidence map›Paper›PMID 40158848›Full record

Observational studyChest2025

The Association Between Mechanical Power Within the First 24 Hours and ICU Mortality in Mechanically Ventilated Adult Patients With Acute Hypoxemic Respiratory Failure: A Registry-Based Cohort Study.

Stephan von Düring, Kuan Liu, Laveena Munshi, S Joseph Kim, Martin Urner, Neill K J Adhikari, Ken Kuljit S Parhar, Eddy Fan

Registry-linked trialAbstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Chest, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07790133 (Pilot Trial Evaluating a Mechanical Power Targeted Ventilation Strategy in Adult VV ECMO Patients With Severe ARDS), which is not on this map. Cited by 12 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

NCT07790133 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

Pilot Trial Evaluating a Mechanical Power Targeted Ventilation Strategy in Adult VV ECMO Patients With Severe ARDS

TypeinterventionalSponsorUniversity of VirginiaRan2026 to 2028Enrolled24ConditionsARDS (Acute Respiratory Distress Syndrome), VV ECMOArmsMechanical Power Targeted Ventilation
3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Review
  5. Article
  6. Article
  7. The role of mechanical power in lung ventilation for the prevention of ventilator-induced lung injury: a narrative review.European respiratory review : an official journal of the European Respiratory Society · 2026
    Review
  8. Article
  9. Article
  10. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Stephan von DüringDivision of Intensive Care Medicine, Department of Acute Care Medicine, Geneva University Hospitals, Geneva, Switzerland; Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Kuan LiuInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Laveena MunshiInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
S Joseph KimInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Nephrology, University Health Network, Toronto, ON, Canada.
Martin UrnerInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada.
Neill K J AdhikariInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Ken Kuljit S ParharDepartment of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada.
Eddy FanInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Respirology, Department of Medicine, University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, Toronto, ON, Canada. Electronic address: eddy.fan@uhn.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDespite 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

methodsIn 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.

resultsOf 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.

interpretationIn 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.

Indexed as

HypoxiaIntensive Care UnitsRespiration, ArtificialRespiratory InsufficiencyAgedCohort StudiesFemaleHospital MortalityHumansMaleMiddle AgedRegistriesTime FactorsVentilator-Induced Lung Injurypositive-pressure respirationpulmonary ventilationrespiratory distress syndromerespiratory insufficiencyventilator-induced lung injury

Identifiers

PMID40158848
PMCPMC12597590

What OpenQuestion holds

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LicenceCC BY
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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.