Alveolar mechanics at the bedside

Joshua Hu, Yusuke Hirao

Abstract

Mechanical power has recently emerged as an important indicator of ventilator lung injury, and mortality. Most studies have focused on the whole respiratory system mechanical power, and few have studied the trans-pulmonary mechanical power.

A newer calculation highlighted the concept of alveolar mechanical power. In this brief review, we illustrate the various types and different calculations of the respiratory system, lung, and alveolar mechanical power.

Keywords

Mechanical power, trans-pulmonary mechanical power, alveolar mechanical power.

References

1. AK AK, Anjum F. Ventilator-Induced Lung Injury (VILI) [Updated 2023 Apr 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563244/

2. Guérin C, Papazian L, Reignier J, et al. Effect of driving pressure on mortality in ARDS patients during lung protective mechanical ventilation in two randomized controlled trials. Crit Care 2016; 20(1):384. https://doi.org/10.1186/s13054-016-1556-2 PMid:27894328 PMCid:PMC5126997

3. Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, et al. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342(18):1301-1308. https://doi.org/10.1056/NEJM200005043421801 PMid:10793162

4. Serpa Neto A, Deliberato RO, Johnson AEW, et al. Mechanical power of ventilation is associated with mortality in critically ill patients: an analysis of patients in two observational cohorts. Intensive Care Med 2018; 44(11):1914-1922. https://doi.org/10.1007/s00134-018-5375-6 PMid:30291378

5. Azizi BA, Munoz-Acuna R, Suleiman A, et al. Mechanical power and 30-day mortality in mechanically ventilated, critically ill patients with and without Coronavirus Disease-2019: a hospital registry study. J Intensive Care 2023; 11(1):14. https://doi.org/10.1186/s40560-023-00662-7 PMid:37024938 PMCid:PMC10077655

6. Gattinoni L, Tonetti T, Cressoni M, et al. Ventilator-related causes of lung injury: the mechanical power. Intensive Care Med 2016; 42(10):1567-1575. https://doi.org/10.1007/s00134-016-4505-2 PMid:27620287

7. Daoud EG, Franck CL. Alveolar mechanics: A new concept in respiratory monitoring. J Mech Vent 2022; 3(4):178-188. https://doi.org/10.53097/JMV.10065

8. Daoud EG, Shimabukuro R. Mechanical ventilation for the non-critical care trained practitioner. Part 1. J Mech Vent 2020; 1(2):39-51. https://doi.org/10.53097/JMV.10011

9. Tonetti T, Vasques F, Rapetti F, et al. Driving pressure and mechanical power: new targets for VILI prevention. Ann Transl Med. 2017;5(14):286. https://doi.org/10.21037/atm.2017.07.08 PMid:28828361 PMCid:PMC5537108

10. Zhang Z, Zheng B, Liu N, et al. Mechanical power normalized to predicted body weight as a predictor of mortality in patients with acute respiratory distress syndrome. Intensive Care Med 2019; 45(6):856-864. https://doi.org/10.1007/s00134-019-05627-9 PMid:31062050

11. Talmor D, Sarge T, Malhotra A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury. N Engl J Med 2008; 359(20):2095-2104. https://doi.org/10.1056/NEJMoa0708638 PMid:19001507 PMCid:PMC3969885

12. Williams EC, Motta-Ribeiro GC, Vidal Melo MF. Driving pressure and transpulmonary pressure: How do we guide safe mechanical ventilation? Anesthesiology 2019; 131(1):155-163 https://doi.org/10.1097/ALN.0000000000002731 PMid:31094753 PMCid:PMC6639048

13. Cressoni M, Cadringher P, Chiurazzi C, et al. Lung inhomogeneity in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 2014; 189(2):149-158. https://doi.org/10.1164/rccm.201308-1567OC PMid:24261322

14. Coppola S, Caccioppola A, Froio S, et al. Effect of mechanical power on intensive care mortality in ARDS patients. Crit Care 2020; 24(1):246. https://doi.org/10.1186/s13054-020-02963-x PMid:32448389 PMCid:PMC7245621

15. Keitoku K, Yeo J, Cabbat R, et al. Mechanical power and Power Compliance Index in independent lung ventilation. New insight A bench study. J Mech Vent 2022; 3(3):124-131. https://doi.org/10.53097/JMV.10057

16. Kreit JW. Volume capnography in the intensive care unit: potential clinical applications. Ann Am Thorac Soc 2019; 16(4):409-420. https://doi.org/10.1513/AnnalsATS.201807-502CME PMid:30742490

17. Lecompte-Osorio P, Pearson SD, Pieroni CH, et al. Bedside estimates of dead space using end-tidal CO2 are independently associated with mortality in ARDS. Crit Care 2021; 25(1):333. https://doi.org/10.1186/s13054-021-03751-x PMid:34526077 PMCid:PMC8442447

18. Verscheure S, Massion PB, Verschuren F, et al. Volumetric capnography: lessons from the past and current clinical applications. Crit Care 2016; 20(1):184. https://doi.org/10.1186/s13054-016-1377-3 PMid:27334879 PMCid:PMC4918076