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Article Dans Une Revue Journal of Intensive Care Année : 2023

Mechanical power and 30-day mortality in mechanically ventilated, critically ill patients with and without Coronavirus Disease-2019: a hospital registry study

Basit Azizi
  • Fonction : Auteur
Ricardo Munoz-Acuna
  • Fonction : Auteur
Aiman Suleiman
  • Fonction : Auteur
Elena Ahrens
  • Fonction : Auteur
Simone Redaelli
  • Fonction : Auteur
Tim Tartler
  • Fonction : Auteur
Guanqing Chen
  • Fonction : Auteur
Daniel Talmor
  • Fonction : Auteur
Elias Baedorf-Kassis
  • Fonction : Auteur
Maximilian Schaefer

Résumé

Abstract Background Previous studies linked a high intensity of ventilation, measured as mechanical power, to mortality in patients suffering from “classic” ARDS. By contrast, mechanically ventilated patients with a diagnosis of COVID-19 may present with intact pulmonary mechanics while undergoing mechanical ventilation for longer periods of time. We investigated whether an association between higher mechanical power and mortality is modified by a diagnosis of COVID-19. Methods This retrospective study included critically ill, adult patients who were mechanically ventilated for at least 24 h between March 2020 and December 2021 at a tertiary healthcare facility in Boston, Massachusetts. The primary exposure was median mechanical power during the first 24 h of mechanical ventilation, calculated using a previously validated formula. The primary outcome was 30-day mortality. As co-primary analysis, we investigated whether a diagnosis of COVID-19 modified the primary association. We further investigated the association between mechanical power and days being alive and ventilator free and effect modification of this by a diagnosis of COVID-19. Multivariable logistic regression, effect modification and negative binomial regression analyses adjusted for baseline patient characteristics, severity of disease and in-hospital factors, were applied. Results 1,737 mechanically ventilated patients were included, 411 (23.7%) suffered from COVID-19. 509 (29.3%) died within 30 days. The median mechanical power during the first 24 h of ventilation was 19.3 [14.6–24.0] J/min in patients with and 13.2 [10.2–18.0] J/min in patients without COVID-19. A higher mechanical power was associated with 30-day mortality (OR adj 1.26 per 1-SD, 7.1J/min increase; 95% CI 1.09–1.46; p = 0.002). Effect modification and interaction analysis did not support that this association was modified by a diagnosis of COVID-19 (95% CI, 0.81–1.38; p -for-interaction = 0.68). A higher mechanical power was associated with a lower number of days alive and ventilator free until day 28 (IRR adj 0.83 per 7.1 J/min increase; 95% CI 0.75–0.91; p < 0.001, adjusted risk difference − 2.7 days per 7.1J/min increase; 95% CI − 4.1 to − 1.3). Conclusion A higher mechanical power is associated with elevated 30-day mortality. While patients with COVID-19 received mechanical ventilation with higher mechanical power, this association was independent of a concomitant diagnosis of COVID-19.
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hal-04071709 , version 1 (23-04-2023)

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Basit Azizi, Ricardo Munoz-Acuna, Aiman Suleiman, Elena Ahrens, Simone Redaelli, et al.. Mechanical power and 30-day mortality in mechanically ventilated, critically ill patients with and without Coronavirus Disease-2019: a hospital registry study. Journal of Intensive Care, 2023, 11 (1), pp.14. ⟨10.1186/s40560-023-00662-7⟩. ⟨hal-04071709⟩
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