ArticleFrontiers in medicine2026
Adjusting inspiratory rise time alters mechanical power in acute respiratory distress syndrome: opposing effects in pressure-controlled and volume-controlled ventilation modes.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Mechanical power (MP), a predictor of ventilator-induced lung injury (VILI), is influenced by ventilatory parameters such as inspiratory rise time (Tslope). While Tslope affects the flow profile, its impact on MP in acute respiratory distress syndrome (ARDS) has not been thoroughly studied, particularly using the geometric method. Methods: In this prospective observational study, 30 deeply sedated and paralyzed ARDS patients were ventilated in both volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) modes using a Maquet Servo-u ventilator. At inspiratory-to-expiratory (I:E) ratios of 1:2 and 1:1, Tslope was adjusted from 5 to 15%, and pressure-volume (P-V) loop screenshots were captured. Geometric mechanical power (MPtotal) was calculated based on the area enclosed by the P-V loops. A total of 720 images were analyzed. Results: In VCV mode, increasing Tslope from 5 to 15% led to a statistically significant increase in MPtotal: 0.8 J/min (5%) at I:E 1:2 and 0.1 J/min (1%) at I:E 1:1. Conversely, in PCV mode, Tslope prolongation resulted in a significant decrease in MPtotal: 1.8 J/min (12.5%) at I:E 1:2 and 1 J/min (7%) at I:E 1:1. No intrinsic PEEP was detected. Conclusion: Modifying Tslope alters MPtotal in opposing directions in PCV and VCV modes. In VCV, prolonging Tslope from 5 to 15% increased MP, whereas increasing the I:E ratio from 1:2 to 1:1 reduced MP. In PCV, prolongation of Tslope from 5 to 15% decreased MP by more than 1 J/min, and changes in the I:E ratio exerted minimal effects on MP.
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