{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T16:10:19Z","timestamp":1783959019990,"version":"3.55.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","license":[{"start":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T00:00:00Z","timestamp":1775606400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Static thresholds for mechanical power (MP) may not prevent ventilator-induced lung injury because risk depends on exposure duration and the underlying respiratory compliance. We aimed to quantify how MP intensity and exposure duration interact with respiratory compliance to predict oxygenation changes consistent with acute respiratory distress syndrome worsening or 14-day mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>A retrospective analysis of 2 large intensive care datasets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>ICUs in the Netherlands and the United States from 2003 to 2016 and 2008 to 2019, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients:<\/jats:title>\n                    <jats:p>Mechanically ventilated adults with oxygenation levels consistent with moderate to severe acute respiratory distress syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions:<\/jats:title>\n                    <jats:p>None.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results:<\/jats:title>\n                    <jats:p>Time-dependent Cox proportional hazards models stratified by respiratory compliance estimated the hour-specific associations of immediate exceedance and cumulative time above MP thresholds with the primary outcome. Estimated effects were integrated into a risk-adjusted mechanical-power score. Among 2150 mechanically ventilated acute respiratory distress syndrome patients risk from MP exposure was dictated by respiratory compliance: in higher-compliance lungs, risk followed a dose-response pattern, with immediate hazard beginning at 10 J\/min (hazard ratio = 1.04) and cumulative harm amplifying significantly over time. Conversely, for low-compliance patients, risk was confined to a narrow power band (11\u201320 J\/min) without evidence of cumulative harm. With risk-adjusted MP score as a predictor of outcome eXtreme Gradient Boosting yielded an area under the receiver operating characteristic curve of 0.863.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A single \u201csafe\u201d MP threshold is insufficient for guiding ventilation; the risk of lung injury is governed by a dynamic interplay of power intensity, duration, and the patient\u2019s respiratory compliance. The risk-adjusted MP score unifies these factors into a time-varying, clinically interpretable metric that warrants prospective validation for personalized ventilator management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/ccm.0000000000007129","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T19:00:28Z","timestamp":1775588428000},"page":"1574-1584","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Power, Duration, and Compliance: Reframing Risk of Ventilatory-Induced Lung Injury With the Risk-Adjusted Mechanical-Power Score"],"prefix":"10.1097","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6712-9456","authenticated-orcid":false,"given":"Lada","family":"Lijovi\u0107","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam Public Health, Amsterdam Cardiovascular Science, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands."},{"name":"Department of Anesthesiology, Intensive Care and Pain Management, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Hilders","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam Public Health, Amsterdam Cardiovascular Science, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomislav","family":"Rado\u010daj","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Pain Management, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mladen","family":"\u0160iranovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Intensive Care and Pain Management, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Elbers","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam Public Health, Amsterdam Cardiovascular Science, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,8]]},"reference":[{"key":"R1-20260713","first-page":"2526","article-title":"Acute respiratory distress syndrome: The Berlin definition.","volume":"307","year":"2012","journal-title":"JAMA"},{"key":"R2-20260713","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40635-024-00712-w","article-title":"Mechanical power and VILI: Modeling limits and unknowns.","volume":"13","author":"Tonetti","year":"2025","journal-title":"Intensive Care Med Exp"},{"key":"R3-20260713","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1164\/rccm.201908-1545CI","article-title":"Static and dynamic contributors to ventilator-induced lung injury in clinical practice. Pressure, energy, and power.","volume":"201","author":"Marini","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"key":"R4-20260713","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s40635-024-00699-4","article-title":"How to minimize mechanical power during controlled mechanical ventilation.","volume":"12","author":"Fabry","year":"2024","journal-title":"Intensive Care Med Exp"},{"key":"R5-20260713","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s40635-024-00649-0","article-title":"Mechanical power ratio threshold for ventilator-induced lung injury.","volume":"12","author":"D\u2019Albo","year":"2024","journal-title":"Intensive Care Med Exp"},{"key":"R6-20260713","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1007\/s00134-016-4505-2","article-title":"Ventilator-related causes of lung injury: The mechanical power.","volume":"42","author":"Gattinoni","year":"2016","journal-title":"Intensive Care Med"},{"key":"R7-20260713","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1164\/rccm.202307-1292VP","article-title":"Mechanical power and ventilator-induced lung injury: What does physics have to say?","volume":"209","author":"Bates","year":"2024","journal-title":"Am J Respir Crit Care Med"},{"key":"R8-20260713","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1097\/ALN.0000000000001056","article-title":"Mechanical power and development of ventilator-induced lung injury.","volume":"124","author":"Cressoni","year":"2016","journal-title":"Anesthesiology"},{"key":"R9-20260713","doi-asserted-by":"crossref","first-page":"1914","DOI":"10.1007\/s00134-018-5375-6","article-title":"Mechanical power of ventilation is associated with mortality in critically ill patients: An analysis of patients in two observational cohorts.","volume":"44","author":"Serpa Neto","year":"2018","journal-title":"Intensive Care Med"},{"key":"R10-20260713","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1186\/s40001-024-02082-1","article-title":"Impact of mechanical power on ICU mortality in ventilated critically ill patients: A retrospective study with continuous real-life data.","volume":"29","author":"Manrique","year":"2024","journal-title":"Eur J Med Res"},{"key":"R11-20260713","doi-asserted-by":"crossref","first-page":"4236","DOI":"10.1038\/s41598-020-77300-x","article-title":"Imaging atelectrauma in ventilator-induced lung injury using 4D X-ray microscopy.","volume":"11","author":"Fardin","year":"2021","journal-title":"Sci Rep"},{"key":"R12-20260713","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/s13054-024-04918-y","article-title":"Stress & strain in mechanically nonuniform alveoli using clinical input variables: A simple conceptual model.","volume":"28","author":"Marini","year":"2024","journal-title":"Crit Care"},{"key":"R13-20260713","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1186\/s13054-020-02963-x","article-title":"Effect of mechanical power on intensive care mortality in ARDS patients.","volume":"24","author":"Coppola","year":"2020","journal-title":"Crit Care"},{"key":"R14-20260713","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1007\/s00134-023-06991-3","article-title":"Mechanical power: Meaning, uses and limitations.","volume":"49","author":"Gattinoni","year":"2023","journal-title":"Intensive Care Med"},{"key":"R15-20260713","doi-asserted-by":"crossref","first-page":"e563","DOI":"10.1097\/CCM.0000000000004916","article-title":"Sharing ICU patient data responsibly under the Society Of Critical Care Medicine\/European Society of Intensive Care Medicine Joint Data Science Collaboration: The Amsterdam University Medical Centers Database (AmsterdamUMCdb) Example*.","volume":"49","author":"Thoral","year":"2021","journal-title":"Crit Care Med"},{"key":"R16-20260713","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41597-022-01899-x","article-title":"MIMIC-IV, a freely accessible electronic health record dataset.","volume":"10","author":"Johnson","year":"2023","journal-title":"Sci Data"},{"key":"R17-20260713","doi-asserted-by":"crossref","first-page":"e711","DOI":"10.1097\/CCM.0000000000002316","article-title":"Validation of intensive care and mechanical ventilation codes in Medicare data.","volume":"45","author":"Wunsch","year":"2017","journal-title":"Crit Care Med"},{"key":"R18-20260713","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1186\/s13054-020-03116-w","article-title":"Bedside calculation of mechanical power during volume- and pressure-controlled mechanical ventilation.","volume":"24","author":"Chiumello","year":"2020","journal-title":"Crit Care"},{"key":"R21-20260713","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1164\/rccm.201010-1757OC","article-title":"Lung stress and strain during mechanical ventilation.","volume":"183","author":"Protti","year":"2011","journal-title":"Am J Respir Crit Care Med"},{"key":"R22-20260713","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1001\/jama.2016.0291","article-title":"Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries.","volume":"315","author":"Bellani","year":"2016","journal-title":"JAMA"},{"key":"R23-20260713","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1186\/s13054-016-1556-2","article-title":"Effect of driving pressure on mortality in ARDS patients during lung protective mechanical ventilation in two randomized controlled trials.","volume":"20","author":"Gu\u00e9rin","year":"2016","journal-title":"Crit Care"},{"key":"R24-20260713","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/S2213-2600(20)30325-8","article-title":"Time-varying intensity of mechanical ventilation and mortality in patients with acute respiratory failure: A registry-based, prospective cohort study.","volume":"8","author":"Urner","year":"2020","journal-title":"Lancet Respir Med"},{"key":"R25-20260713","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1513\/AnnalsATS.201812-910OC","article-title":"Epidemiology, mechanical power, and 3-year outcomes in acute respiratory distress syndrome patients using standardized screening. An observational cohort study.","volume":"16","author":"Parhar","year":"2019","journal-title":"Ann Am Thorac Soc"},{"key":"R26-20260713","doi-asserted-by":"crossref","first-page":"1378","DOI":"10.1164\/rccm.202009-3536OC","article-title":"Effect of lowering vt on mortality in acute respiratory distress syndrome varies with respiratory system elastance.","volume":"203","author":"Goligher","year":"2021","journal-title":"Am J Respir Crit Care Med"},{"key":"R27-20260713","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1097\/ALN.0000000000002203","article-title":"Energetics and the root mechanical cause for ventilator-induced lung injury.","volume":"128","author":"Marini","year":"2018","journal-title":"Anesthesiology"},{"key":"R28-20260713","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1097\/ALN.0000000000000727","article-title":"Lung inhomogeneities and time course of ventilator-induced mechanical injuries.","volume":"123","author":"Cressoni","year":"2015","journal-title":"Anesthesiology"},{"key":"R29-20260713","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s13054-020-03428-x","article-title":"Mechanical power during extracorporeal membrane oxygenation and hospital mortality in patients with acute respiratory distress syndrome.","volume":"25","author":"Chiu","year":"2021","journal-title":"Crit Care"},{"key":"R30-20260713","doi-asserted-by":"crossref","first-page":"28240","DOI":"10.1038\/s41598-024-79899-7","article-title":"Machine learning-based model for predicting the occurrence and mortality of nonpulmonary sepsis-associated ARDS.","volume":"14","author":"Lin","year":"2024","journal-title":"Sci Rep"},{"key":"R31-20260713","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1177\/08850666241281060","article-title":"Predicting mortality in sepsis-associated acute respiratory distress syndrome: A machine learning approach using the MIMIC-III database.","volume":"40","author":"Mu","year":"2025","journal-title":"J Intensive Care Med"}],"container-title":["Critical Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/CCM.0000000000007129","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T16:00:14Z","timestamp":1783958414000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/CCM.0000000000007129"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,8]]},"references-count":29,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/ccm.0000000000007129","relation":{},"ISSN":["0090-3493","1530-0293"],"issn-type":[{"value":"0090-3493","type":"print"},{"value":"1530-0293","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,8]]}}}