{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:51:40Z","timestamp":1789685500061,"version":"4.0.1"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T00:00:00Z","timestamp":1736726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100015084","name":"Lung Foundation Netherlands","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100015084","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100019573","name":"Amsterdam University Medical Centers","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019573","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>High mechanical power is associated with mortality in patients who are critically ill and require invasive ventilation. It remains uncertain which components of mechanical power \u2013 volume, pressure or rate \u2013 increase mechanical power the most.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a post hoc analysis of a database containing individual patient data from three randomised clinical trials of ventilation in patients without acute respiratory distress syndrome. The primary endpoint was mechanical power. We used linear regression; double stratification to create subgroups of participants; and mediation analysis to assess the impact of changes in volumes, pressures and rates on mechanical power.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1732 patients were included and analysed. The median (IQR [range]) mechanical power was 12.3 (9.3\u201317.1 [3.7\u201350.1]) J.min\n                      <jats:sup>\u20101<\/jats:sup>\n                      . In linear regression, respiratory rate (36%) and peak pressure (51%) explained most of the increase in mechanical power. Increasing quintiles of peak pressure stratified on constant levels of respiratory rate resulted in higher risks of high mechanical power (relative risk 2.2 (95%CI 1.8\u20132.6), p\u2009&lt;\u20090.01), while decreasing quintiles of respiratory rate stratified on constant levels of peak pressure resulted in lower risks of high mechanical power (relative risk 0.2 (95%CI 0.2\u20130.3), p\u2009&lt;\u20090.01). Mediation analysis showed that a reduction in respiratory rate, with the increase in tidal volume, partially mediates an effect of reduction in mechanical power (average causal mediation effect \u20100.10, 95%CI \u20100.12 to \u20100.09, p\u2009&lt;\u20090.01), but still with a direct effect of tidal volume on mechanical power (average direct effect 0.15, 95%CI 0.11\u20130.19, p\u2009&lt;\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In this cohort of patients without acute respiratory distress syndrome, pressure and respiratory rate were the most important determinants of mechanical power. The respiratory rate may be the most attractive ventilator setting to adjust when targeting a lower mechanical power.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.16537","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T21:23:33Z","timestamp":1736803413000},"page":"533-542","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Association of ventilation volumes, pressures and rates with the mechanical power of ventilation in patients without acute respiratory distress syndrome: exploring the impact of rate reduction"],"prefix":"10.1111","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9569-2462","authenticated-orcid":false,"given":"Laura A.","family":"Buiteman\u2010Kruizinga","sequence":"first","affiliation":[{"name":"Department of Intensive Care Reinier de Graaf Hospital  Delft the Netherlands"},{"name":"Department of Intensive Care Amsterdam University Medical Centers \u2018location AMC\u2019  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M. P.","family":"van Meenen","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Amsterdam University Medical Centers \u2018location AMC\u2019  Amsterdam the Netherlands"},{"name":"Department of Anaesthesiology Amsterdam University Medical Centers \u2018location AMC\u2019  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ary","family":"Serpa Neto","sequence":"additional","affiliation":[{"name":"Australian and New Zealand Intensive Care\u2010Research Centre Monash University  Melbourne VIC Australia"},{"name":"Department of Intensive Care Austin Hospital  Melbourne VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guido","family":"Mazzinari","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care La Fe University and Polytechnic Hospital  Valencia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lieuwe D. J.","family":"Bos","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Amsterdam University Medical Centers \u2018location AMC\u2019  Amsterdam the Netherlands"},{"name":"Department of Respiratory Medicine Amsterdam University Medical Centers \u2018location AMC\u2019  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pim L. J.","family":"van der Heiden","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Reinier de Graaf Hospital  Delft the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederique","family":"Paulus","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Amsterdam University Medical Centers \u2018location AMC\u2019  Amsterdam the Netherlands"},{"name":"Faculty of Health, ACHIEVE, Centre of Applied Research Amsterdam University of Applied Sciences  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus J.","family":"Schultz","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Amsterdam University Medical Centers \u2018location AMC\u2019  Amsterdam the Netherlands"},{"name":"Division of Cardiothoracic and Vascular Anaesthesia &amp; Critical Care Medicine, Department of Anaesthesia, General Intensive Care and Pain Management Medical University Wien  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