Comprehensive study of mechanical power in controlled mechanical ventilation: Prevalence of elevated mechanical power and component analysis.

OBJECTIVE: To determine the prevalence of elevated mechanical power (MP) values (>17J/min) used in routine clinical practice. DESIGN: Observational, descriptive, cross-sectional, analytical, multicenter, international study conducted on November 21, 2019, from 8:00 AM to 3:00 PM. NCT03936231. SETTING: One hundred thirty-three Critical Care Units. PATIENTS: Patients receiving invasive mechanical ventilation for any cause. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Mechanical power. RESULTS: A population of 372 patients was analyzed. PM was significantly higher in patients under pressure-controlled ventilation (PC) compared to volume-controlled ventilation (VC) (19.20±8.44J/min vs. 16.01±6.88J/min; p<0.001), but the percentage of patients with PM>17J/min was not different (41% vs. 35%, respectively; p=0.382). The best models according to AICcw expressing PM for patients in VC are described as follows: Surrogate Strain (Driving Pressure) + PEEP+Surrogate Strain Rate (PEEP/Flow Ratio) + Respiratory Rate. For patients in PC, it is defined as: Surrogate Strain (Expiratory Tidal Volume/PEEP) + PEEP+Surrogate Strain Rate (Surrogate Strain/Ti) + Respiratory Rate+Expiratory Tidal Volume+Ti. CONCLUSIONS: A substantial proportion of mechanically ventilated patients may be at risk of experiencing elevated levels of mechanical power. Despite observed differences in mechanical power values between VC and PC ventilation, they did not result in a significant disparity in the prevalence of high mechanical power values.

Health-related quality of life as a prognostic factor of survival in critically ill patients.

OBJECTIVE: To evaluate whether health-related quality of life prior to admission into an intensive care unit (ICU) is a prognostic factor of hospital and 1 year mortality. DESIGN: Prospective cohort study. SETTING: Fourteen-bed medical-surgical ICU. PATIENTS: A total of 377 patients admitted to the ICU for more than 24 h with 1-year follow-up after discharge from the hospital. INTERVENTION: A health-related quality of life (HRQoL) survey was conducted, using the questionnaire developed by the "Project for the Epidemiological Analysis of Critical Care Patients", to assess patient's quality of life 1 month before ICU hospitalization. RESULTS: Hospital mortality was independently associated with severity assessed by APACHE II, odds ratio (OR) 1.14 [95% confidence interval (CI) 1.08-1.2; P < 0.001], high workload assessed by Nine Equivalents of Nursing Manpower Score > 30 OR 3.6 (95% CI 1.4-9.0; P = 0.006), hospital length of stay prior to ICU admission of more than 2 days OR 2.6 (95% CI 1.3-5.4; P = 0.008), and bad quality of life prior to ICU admission assessed by a HRQoL score > or = 8 points OR 2.2 (95% CI 1.03-4.5; P = 0.04). Patients who scored > or =8 on the HRQoL survey presented a risk of demise 12 months after discharge almost twofold that of those who had good previous HRQoL (0-2 points), Hazard Ratio 1.9 (95% CI 1.3-2.8; P = 0.001). CONCLUSION: Bad quality of life is associated with hospital mortality and survival 12 months after hospital discharge.