Association between mean airway pressure and 90-day mortality in ventilator-associated pneumonia

Objective We performed a retrospective cohort analysis to assess the association between mean airway pressure (Pmean) during mechanical ventilation and 90-day mortality in patients with ventilator-associated pneumonia (VAP). Results Of the 2,911 VAP cases retrieved from MIMIC-IV, 693 patients (23.8%) had died within 90 days. Non-survivors showed a significantly higher average Pmean than survivors (median [IQR]:10.80 [8.85, 13.89] vs. 9.89 [8.28, 12.04]; P < 0.001). The area under the receiver operating characteristic (ROC) curve (AUC) for average Pmean was 0.591. When patients were divided by median Pmean (10.06 cmH₂O), those with higher values had worse 90-day survival (log-rank P < 0.001). Conclusions Higher average Pmean was associated with increased 90-day mortality in VAP. These univariable results suggest an association, but validation with multivariable and prospective studies is needed.