Protective mechanical ventilation controlled by the real-time mechanical power measurement

Despite the substantial advancements in mechanical ventilation (MV), mortality remains high. Mechanical power (MP), MV forces are associated with outcomes. Real-time monitoring of MP and the adjustment of MV according to MP may result in ventilation with lower MP. Randomized controled trial conducted at the ECMO Centre Ostrava, Czech Republic, from March 2023 to March 2024 enrolled adult patients on MV (with or without extracorporeal membrane oxygenation, ECMO) with acute respiratory failure. A system for real-time MP monitoring (geometric method and simplified Becher´s formula) has been developed. In the intervention arm, the physician was able to observe the MP in real time and adjust the MV parameters accordingly. In the control group, the MP was concealed. A total of 494 subjects were screened and 33 patients were randomized (further 7 ECMO patients). There was no significant difference between the control and intervention groups. Median MPGeom was 3.22 J/min (maximum 15.2 J/min) and MPBecher of 5.94 J/min (maximum 18.4 J/min). Only a weak (but significant, p = 0.0001) correlation between MPGeom and MPBecher was observed. A highly significant difference was observed in MP between day and night (6 a.m. − 6 p.m.) with higher MP at night. Although real-time MP measurement is feasible, there was no significant difference in MP between the control and intervention groups with low MP in both groups. Experience physicians was capable of safe MV, even if they do not know the exact MP value. The night shift was a high-risk period for developing lung damage due to elevated MP. ClinicalTrials NCT06035146.