{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T11:25:15Z","timestamp":1763983515217,"version":"3.45.0"},"reference-count":37,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T00:00:00Z","timestamp":1763769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Driving pressure (DP) and components of mechanical power (MP) have been proposed as prognostic markers in ARDS. The prognostic significance of these parameters in COVID-19\u2013associated ARDS (C-ARDS), particularly during the early phase of intensive care unit (ICU) stay, remains uncertain. Materials and Methods: A retrospective single-center cohort of 310 C-ARDS patients receiving invasive mechanical ventilation was analyzed. Ventilator data from the first 72 h after ICU admission were retrieved. DP, total mechanical power (MPtot), and dynamic mechanical power (MPdyn) were calculated. The primary endpoint was defined as ICU mortality; secondary endpoints were ventilator-free days (VFDs) and length of stay (LOS) in ICU. ROC analyses, Cox proportional hazards regression, and Kaplan\u2013Meier survival estimates were applied. Results: DP \u2265 15.72 cm H2O and MPdyn \u2265 10.08 J\/min were found to be significantly associated with increased ICU mortality (HR 1.9 [1.5\u20132.5], p &lt; 0.0001; HR 1.5 [1.2\u20131.9], p = 0.0036, respectively), whereas MPtot \u2265 18.6 J\/min was not (p = 0.1). Patients with DP below the threshold demonstrated longer VFDs, and higher survival probabilities. No significant differences in VFDs were identified for MPdyn or MPtot. Conclusions: In C-ARDS patients, early measurements of DP and MPdyn were independently associated with ICU mortality, while MPtot was not. Among these parameters, DP may be regarded as the most practical marker due to its ease of calculation and potential utility in guiding lung-protective ventilation strategies.<\/jats:p>","DOI":"10.3390\/medicina61122086","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T10:24:17Z","timestamp":1763979857000},"page":"2086","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is Mechanical Power the Trojan Horse? Emphasizing the Role of Driving Pressure"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9899-0545","authenticated-orcid":false,"given":"Dicle","family":"Birtane","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul 34147, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0534-7973","authenticated-orcid":false,"given":"Furkan","family":"Tontu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8893-3977","authenticated-orcid":false,"given":"Zafer","family":"\u00c7ukurova","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul 34147, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sinan","family":"A\u015far","sequence":"additional","affiliation":[{"name":"Department of Reanimation, Mardin Research and Training Hospital, Mardin 47100, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1164\/rccm.201605-1081CP","article-title":"Mechanical ventilation to minimize progression of lung injury in acute respiratory failure","volume":"195","author":"Brochard","year":"2017","journal-title":"Am. 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