{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T02:01:23Z","timestamp":1787796083124,"version":"build-2784847793"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T00:00:00Z","timestamp":1637193600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    High intensity of ventilation has an association with mortality in patients with acute respiratory failure. It is uncertain whether similar associations exist in patients with acute respiratory distress syndrome (ARDS) patients due to coronavirus disease 2019 (COVID\u221219). We investigated the association of exposure to different levels of driving pressure (\u0394P) and mechanical power (MP) with mortality in these patients.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    PRoVENT\u2013COVID is a national, retrospective observational study, performed at 22 ICUs in the Netherlands, including COVID\u221219 patients under invasive ventilation for ARDS. Dynamic \u0394P and MP were calculated at fixed time points during the first 4 calendar days of ventilation. The primary endpoint was 28\u2013day mortality. To assess the effects of time\u2013varying exposure, Bayesian joint models adjusted for confounders were used.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    Of 1,122 patients included in the PRoVENT\u2013COVID study, 734 were eligible for this analysis. In the first 28 days, 29.2% of patients died. A significant increase in the hazard of death was found to be associated with each increment in \u0394P (HR 1.04, 95% CrI 1.01\u20131.07) and in MP (HR 1.12, 95% CrI 1.01\u20131.36). In sensitivity analyses, cumulative exposure to higher levels of \u0394P or MP resulted in increased risks for 28\u2013day mortality.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    Cumulative exposure to higher intensities of ventilation in COVID\u221219 patients with ARDS have an association with increased risk of 28\u2013day mortality. Limiting exposure to high \u0394P or MP has the potential to improve survival in these patients.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Clinical Trial Registration:<\/jats:bold>\n                    <jats:ext-link>www.ClinicalTrials.gov<\/jats:ext-link>\n                    , identifier: NCT04346342.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2021.725265","type":"journal-article","created":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T04:35:05Z","timestamp":1637210105000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Association of Time\u2013Varying Intensity of Ventilation With Mortality in Patients With COVID\u221219 ARDS: Secondary Analysis of the PRoVENT\u2013COVID Study"],"prefix":"10.3389","volume":"8","author":[{"given":"Michiel T. 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