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Publications

Journal Article Ahead of print

PubMed: 42677970 DOI: 10.1177/19433654261479378

Elastic Ventilatory Energy Predicts ARDS Severity and Mortality: A Bayesian Retrospective Analysis.

Respir Care

Authors: Aurio Fajardo-Campoverdi, Alejandro González-Castro, Patricia R M Rocco, Denise Battaglini, Alberto Medina, Cristina Camilo

Affiliations

  • Dr. Fajardo-Campoverdi is affiliated with the Critical Care and Respiratory Investigation, Viña del Mar, Chile.
  • Dr. González-Castro is affiliated with the Intensive Care Service, Marqués de Valdecilla University Hospital, Santander, Spain.
  • Dr. Rocco is affiliated with the Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
  • Dr. Battaglini is affiliated with the Anesthesia and Intensive Care, IRCCS Azienda Ospedaliera Metropolitana, Genoa, Italy.
  • Dr. Battaglini is affiliated with the Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
  • Dr. Medina is affiliated with the Central University Hospital of Asturias, Oviedo, Spain.
  • Dr. Camilo is affiliated with the Pediatric Intensive Care Unit, Department of Pediatrics, Santa Maria University Hospital-USL Santa Maria, Lisbon, Portugal.

Abstract

BACKGROUND

Mechanical power integrates the energy delivered to the respiratory system during mechanical ventilation but may not reflect the mechanical stress applied to lung tissue. Metrics focused on the elastic component of ventilatory energy may provide a more physiologically relevant estimate of parenchymal stress. We evaluated elastic static power and elastic static power normalized to predicted body weight (PBW) and their association with ARDS severity and mortalityMethods:We conducted a single-center retrospective cohort study in an ICU, analyzed using Bayesian modeling. Adult subjects (N = 137) receiving volume-controlled invasive mechanical ventilation for COVID-19 pneumonia were included, encompassing individuals without ARDS and with mild, moderate, or severe ARDS. Elastic static power and PBW-normalized elastic static power were derived from ventilatory parameters recorded within the first 24 h after initiation of mechanical ventilation. Bayesian regression models were used to evaluate associations between these variables and ARDS severity, ICU mortality, and 28-day mortality.

RESULTS

Posterior distributions for elastic load metrics favored greater ARDS severity and increased mortality. Elastic static power favored moderate-to-severe ARDS (relative risk 1.32, 95% credible interval [CrI] 1.10-1.57), ICU mortality (hazard ratio [HR] 1.36, 95% CrI 1.16-1.60), and 28-day mortality (HR: 1.31, 95% CrI: 1.17-1.48). Similar patterns were observed after normalization to PBW.

CONCLUSIONS

Posterior distributions for elastic ventilatory energy, in both its nonnormalized and PBW-normalized forms, consistently favored greater ARDS severity and mortality. These findings support the use of elastic load metrics as physiologically relevant indicators of ventilatory stress.

MeSH

Mortality, Stress, Physiological, Ventilation