Bedside tip: How to estimate mechanical power in volume- and pressure-control ventilation

24.02.2021
Author: Justin Seemueller, Respiratory Clinical Specialist, Sentara Norfolk General Hospital, Reviewer: Jean-Michel Arnal, Süha Demirakca, David Grooms

As our understanding of VILI grows, there is a greater focus on mechanical power (MP) as a potential predictor of negative outcomes.

Data currently suggests that a MP of 17.0 J/min is associated with higher risk of death [1]. Below is the surrogate corrected method of calculating MP in Volume Control proposed by Gattinoni et al. [2].

If we use the corresponding values shown in the ventilator's Monitoring window:

Below is a simplified method of calculating mechanical power in Pressure Control proposed by Van der Meijden et al. and Becher et al. [3 ].

It is possible to further simplify their formula by replacing "∆Pinsp + PEEP” with plateau pressure, as they are equivalent by definition. Pplateau can be measured by means of an inspiratory hold (available in the Tools window). Alternatively, an estimated value of Pplateau is displayed in the Monitoring window of Hamilton Medical ventilators.

If we use the corresponding values as shown in the Monitoring window:

These formulas may assist in identifying mechanically ventilated patients in need of earlier intervention.

References

  1. Serpa Neto A, Deliberato RO, Johnson AEW et al.; PROVE Network Investigators. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med. 2018 Nov;44(11):1914-1922. doi: 10.1007/s00134-018-5375-6. Epub 2018 Oct 5. PMID: 30291378.
  2. Giosa L, Busana M, Pasticci I et al. Mechanical power at a glance: a simple surrogate for volume-controlled ventilation. Intensive Care Med Exp. 2019 Nov 27;7(1):61. doi: 10.1186/s40635-019-0276-8. PMID: 31773328; PMCID: PMC6879677.
  3. Becher T, van der Staay M, Schädler D et al. Calculation of mechanical power for pressure-controlled ventilation. Intensive Care Med. 2019 Sep;45(9):1321-1323. doi: 10.1007/s00134-019-05636-8. Epub 2019 May 17. PMID: 31101961.

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mechanical power, VILI, lung damage, pressure control, volume control, bedside, plateau pressure
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Date of Printing: 23.04.2021
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