{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T21:03:35Z","timestamp":1790370215868,"version":"4.1.0"},"reference-count":35,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["466655093"],"award-info":[{"award-number":["466655093"]}],"id":[{"id":"10.13039\/501100001659","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":[[2025,12]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Intra\u2010operative supplemental oxygen and mechanical ventilation expose the lungs to potentially injurious energy. This can be quantified as \u2018chemical power\u2019 and \u2018mechanical power\u2019, respectively. In this study, we sought to determine if intra\u2010operative chemical and mechanical power, individually and\/or in combination, are associated with postoperative pulmonary complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using an individual patient data analysis of three randomised clinical trials of intra\u2010operative ventilation, we summarised intra\u2010operative chemical and mechanical power using time\u2010weighted averages. We evaluated the association between intra\u2010operative chemical and mechanical power and a collapsed composite of postoperative pulmonary complications using multivariable logistic regression to estimate the odds ratios related to the effect of 1\u2009J.min\n                      <jats:sup>\u20101<\/jats:sup>\n                      increase in chemical or mechanical power with adjustment for demographic and intra\u2010operative characteristics. We also included an interaction term to assess for potential synergistic effects of chemical and mechanical power on postoperative pulmonary complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 3837 patients recruited to three individual trials, 2492 with full datasets were included in the analysis. Intra\u2010operative time\u2010weighted average (SD) chemical power was 10.2 (3.9) J.min\n                      <jats:sup>\u20101<\/jats:sup>\n                      and mechanical power was 10.5 (4.4) J.min\n                      <jats:sup>\u20101<\/jats:sup>\n                      . An increase of 1\u2009J.min\n                      <jats:sup>\u20101<\/jats:sup>\n                      in chemical power was associated with 8% higher odds of postoperative pulmonary complications (OR 1.08, 95%CI 1.05\u20131.10, p\u2009&lt;\u20090.001), while the same increase in mechanical power raised odds by 5% (OR 1.05, 95%CI 1.02\u20131.08, p\u2009=\u20090.003). We did not find evidence of a significant interaction between chemical and mechanical power (p\u2009=\u20090.40), suggestive of an additive rather than synergistic effect on postoperative pulmonary complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Both chemical and mechanical power are independently associated with postoperative pulmonary complications. Further work is required to determine causality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.16725","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T10:31:53Z","timestamp":1755599513000},"page":"1510-1518","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Individual and combined effects of chemical and mechanical power on postoperative pulmonary complications: a secondary analysis of the\n                    <scp>REPEAT<\/scp>\n                    study"],"prefix":"10.1111","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7984-1798","authenticated-orcid":false,"given":"Lukas M.","family":"M\u00fcller\u2010Wirtz","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Friedrich\u2010Alexander\u2010Universit\u00e4t Erlangen\u2010N\u00fcrnberg, Universit\u00e4tsklinikum Erlangen  Erlangen Germany"},{"name":"Outcomes Research Consortium\u00ae  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4596-2118","authenticated-orcid":false,"given":"Thijs A.","family":"Lilien","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Amsterdam University Medical Center  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1922-5555","authenticated-orcid":false,"given":"William M.","family":"Patterson","sequence":"additional","affiliation":[{"name":"Outcomes Research Consortium\u00ae  Houston TX USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1475-2046","authenticated-orcid":false,"given":"Sascha","family":"Ott","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anesthesiology and Intensive Care Medicine Deutsches Herzzentrum der Charit\u00e9  Berlin Germany"},{"name":"Charit\u00e9\u2010Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt\u2010Universit\u00e4t zu Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1958-9364","authenticated-orcid":false,"given":"Roland C. E.","family":"Francis","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Friedrich\u2010Alexander\u2010Universit\u00e4t Erlangen\u2010N\u00fcrnberg, Universit\u00e4tsklinikum Erlangen  Erlangen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3554-883X","authenticated-orcid":false,"given":"Marcelo","family":"Gama de Abreu","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Critical Care; Division of Cardiothoracic Anesthesia Cleveland Clinic  Cleveland OH USA"},{"name":"Department of Anesthesiology Integrated Health Care Institute, Cleveland Clinic  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1520-9387","authenticated-orcid":false,"given":"Ary","family":"Serpa Neto","sequence":"additional","affiliation":[{"name":"Australian and New Zealand Intensive Care Research Centre (ANZIC\u2010RC), School of Public Health and Preventive Medicine Monash University  Melbourne Australia"},{"name":"Department of Intensive Care Austin Hospital  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9454-5321","authenticated-orcid":false,"given":"Reinout A.","family":"Bem","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Amsterdam University Medical Center  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6574-9034","authenticated-orcid":false,"given":"David M. 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