Association Between Mechanical Power During Prone Positioning and Mortality in Patients With Acute Respiratory Distress Syndrome

作者：Yao Wu, Rong Liufu, Y. Wang, Yan Chen, Shan Li, Run Dong, Jun Xu, Huadong Zhu, Yun Long, Chenqi Zhu, Yuan Guo, Bin Du, Li Weng · 发表于：Critical Care Medicine · 年份：2025 · DOI：10.1097/ccm.0000000000006811 · 被引用次数：6 · 研究领域：Respiratory Support and Mechanisms、Intraoperative Neuromonitoring and Anesthetic Effects、Cardiovascular and Diving-Related Complications

OBJECTIVES: Optimal parameters for evaluating the effectiveness of prone positioning in acute respiratory distress syndrome (ARDS) remain undefined. This study aims to investigate the relationship between dynamic change in mechanical power during prone positioning and mortality in patients with ARDS. DESIGN: This was a single-center retrospective cohort study. SETTING: The Center of Critical Care Medicine of Peking Union Medical College Hospital. PATIENTS: ARDS patients who underwent prone positioning while receiving invasive mechanical ventilation were enrolled. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 1078 patients (720 [66.8%] male; median age, 63 yr [interquartile range (IQR), 51-72 yr]) were enrolled. The median duration of selected prone position sessions was 15.0 hours (IQR, 9.0-17.0 hr). ICU mortality was 20.9% (225/1078). Mechanical power during prone positioning increased in nonsurvivors compared with survivors (0.8 × 10 -2 J/min/kg [IQR, -3.3 to 5.6 × 10 -2 J/min/kg] vs. -0.6 × 10 -2 J/min/kg [IQR, -4.9 to 3.3 × 10 -2 J/min/kg]; p = 0.001). Patients with increased mechanical power during prone positioning had higher ICU mortality (23.9% vs. 17.8%; p = 0.011), in-hospital mortality (25.2% vs. 19.5%; p = 0.018), and 28-day mortality (33.2% vs. 25.4%; p = 0.002). Multivariable time-dependent Cox proportional hazards model confirmed that increased mechanical power was independently associated with higher ICU mortality risk (hazard ratio for each 1...