Optimizing mechanical ventilation: Personalizing mechanical power to reduce ICU mortality ‐ a retrospective cohort study

Alkhalifah, AS; Rumindo, K; Brincat, E; Blanchard, F; Helleberg, J; Clarke, D; Popoff, B; Duranteau, O; Mohamed, ZU; Senosy, A

Journal article

Optimizing mechanical ventilation: Personalizing mechanical power to reduce ICU mortality ‐ a retrospective cohort study

Abstract:: Background: Mechanical ventilation, a crucial intervention for acute respiratory distress syndrome (ARDS), can lead to ventilator-induced lung injury (VILI). This study focuses on individualizing mechanical power (MP) in mechanically ventilated patients to minimize VILI and reduce ICU mortality. Methods: A retrospective analysis was conducted using the Amsterdam University Medical Centers Database (AmsterdamUMCdb) data. The study included patients aged 18 and older who needed at least 48 hours of pressure-controlled mechanical ventilation. Patients who died or were extubated within 48 hours and those with inadequate data were excluded. Patients were categorized into hypoxemia groups based on their PaO2/FiO2 ratio. MP was calculated using a surrogate formula and normalized to ideal body weight (IBW). Statistical analyses and machine learning models, including logistic regression and random forest, were used to predict ICU mortality and establish safe upper limits for IBW-adjusted MP. Results: Out of 23,106 admissions, 2,338 met the criteria. Nonsurvivors had a significantly higher time-weighted average MP (TWA-MP) than survivors. Safe upper limits for IBW-adjusted MP varied across hypoxemia groups. The XGBoost model showed the highest predictive accuracy for ICU mortality. An individualization method for mechanical ventilation settings, based on real-time physiological variables, demonstrated reduced predicted mortality in a subset of patients. Discussion: Elevated TWA-MP is associated with increased ICU mortality, underscoring the need for personalized mechanical ventilation strategies. The study highlights the complexity of VILI and the multifactorial nature of ICU mortality. Further studies to define a safe upper limit for IBW-adjusted MP may help clinicians optimize mechanical ventilation settings and decrease the risk of VILI and mortality. Conclusions: Despite the fact that the study’s retrospective design and reliance on a single-center database may limit the generalizability of findings, this study offers valuable insights into the relationship between mechanical power and ICU mortality, emphasizing the need for individualized mechanical ventilation strategies. The findings suggest a potential for more personalized, data-driven approach in managing mechanically ventilated patients, which could improve patient outcomes in critical care settings.

Publication status:: Published

Peer review status:: Peer reviewed

Actions

Email

Email this record

Send the bibliographic details of this record to your email address.

Your Email
Please enter the email address that the record information will be sent to.

-
Your message (optional)
Please add any additional information to be included within the email.
Cite

Cite this record

APA Style

Alkhalifah, A. S., Rumindo, K., Brincat, E., Blanchard, F., Helleberg, J., Clarke, D., Popoff, B., Duranteau, O., Mohamed, Z. U., & Senosy, A. (2025). Optimizing mechanical ventilation: Personalizing mechanical power to reduce ICU mortality ‐ a retrospective cohort study. PLoS ONE, 20(2).

MLA Style

Alkhalifah, A. S., et al. “Optimizing Mechanical Ventilation: Personalizing Mechanical Power to Reduce ICU Mortality ‐ a Retrospective Cohort Study.” PLoS ONE, vol. 20, no. 2, Public Library of Science, 2025.

Chicago Style

Alkhalifah, AS, K Rumindo, E Brincat, F Blanchard, J Helleberg, D Clarke, B Popoff, O Duranteau, ZU Mohamed, and A Senosy. 2025. “Optimizing Mechanical Ventilation: Personalizing Mechanical Power to Reduce ICU Mortality ‐ a Retrospective Cohort Study.” PLoS ONE 20 (2).
Share
Print