Mechanical Power and Acute Kidney Injury in Mechanically Ventilated Critically Ill Patients: A Single-Center Retrospective Cohort Study.
- 1Department of Anesthesiology and Reanimation, Intensive Care, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul 34147, Turkey.
- 2Department of Anesthesiology and Reanimation, Intensive Care, Marmara University Pendik Training and Research Hospital, Istanbul 34899, Turkey.
Abstract
Background and Objectives: Acute kidney injury (AKI) is highly prevalent among critically ill patients receiving invasive mechanical ventilation (IMV) and is associated with adverse outcomes. Mechanical power (MP) reflects the total energy delivered to the respiratory system, but its association with AKI in mechanically ventilated critically ill patients remains incompletely understood. Few studies have examined the relationship between MP and AKI development. Materials and Methods: Adult patients with MP data available for each of the first five consecutive days of IMV constituted the study population. MP and ventilatory parameters were recorded during this period. Factors independently associated with AKI were identified using multivariable logistic regression. The discriminative performance of MP for AKI and continuous renal replacement therapy (CRRT) use was evaluated. Results: Among 924 patients, 605 (65.5%) developed AKI. MP was consistently higher in patients who developed AKI during the first five days of IMV (11.45 ± 2.88 vs. 9.48 ± 2.50 J/min; p < 0.001). Although PEEP, peak inspiratory pressure, driving pressure, respiratory rate, and FiO₂ were higher in the AKI group, tidal volume and respiratory system compliance did not differ significantly. In multivariable analysis, higher mean MP (OR = 1.330, 95% CI 1.235-1.432; p < 0.001), greater mean fluid balance (OR = 1.477, 95% CI 1.225-1.780; p < 0.001), older age, and trauma were independently associated with AKI. MP showed moderate discrimination for AKI (AUC = 0.681), with an optimal cutoff of 10.38 J/min. For CRRT use, MP showed significant but limited discrimination (AUC = 0.624; 95% CI, 0.584-0.664; p < 0.001). Conclusions: In critically ill patients receiving IMV, higher MP remained associated with AKI after adjustment for measured covariates. The 10.38 J/min threshold is hypothesis-generating and requires external validation.
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BibTeX
@article{cukurova2026mechanical,
title = {{Mechanical Power and Acute Kidney Injury in Mechanically Ventilated Critically Ill Patients: A Single-Center Retrospective Cohort Study.}},
author = {Zafer Çukurova and Dicle Birtane and Mehmet Süleyman Sabaz},
journal = {Medicina (Kaunas, Lithuania)},
year = {2026},
month = sep,
doi = {10.3390/medicina62101868},
url = {https://europepmc.org/article/MED/42942399},
note = {CC BY},
}
RIS
TY - JOUR
TI - Mechanical Power and Acute Kidney Injury in Mechanically Ventilated Critically Ill Patients: A Single-Center Retrospective Cohort Study.
AU - Zafer Çukurova
AU - Dicle Birtane
AU - Mehmet Süleyman Sabaz
PY - 2026
DA - 2026/09/27
JO - Medicina (Kaunas, Lithuania)
DO - 10.3390/medicina62101868
UR - https://europepmc.org/article/MED/42942399
AB - Background and Objectives: Acute kidney injury (AKI) is highly prevalent among critically ill patients receiving invasive mechanical ventilation (IMV) and is associated with adverse outcomes. Mechanical power (MP) reflects the total energy delivered to the respiratory system, but its association with AKI in mechanically ventilated critically ill patients remains incompletely understood. Few studies have examined the relationship between MP and AKI development. Materials and Methods: Adult patients with MP data available for each of the first five consecutive days of IMV constituted the study population. MP and ventilatory parameters were recorded during this period. Factors independently associated with AKI were identified using multivariable logistic regression. The discriminative performance of MP for AKI and continuous renal replacement therapy (CRRT) use was evaluated. Results: Among 924 patients, 605 (65.5%) developed AKI. MP was consistently higher in patients who developed AKI during the first five days of IMV (11.45 ± 2.88 vs. 9.48 ± 2.50 J/min; p < 0.001). Although PEEP, peak inspiratory pressure, driving pressure, respiratory rate, and FiO₂ were higher in the AKI group, tidal volume and respiratory system compliance did not differ significantly. In multivariable analysis, higher mean MP (OR = 1.330, 95% CI 1.235-1.432; p < 0.001), greater mean fluid balance (OR = 1.477, 95% CI 1.225-1.780; p < 0.001), older age, and trauma were independently associated with AKI. MP showed moderate discrimination for AKI (AUC = 0.681), with an optimal cutoff of 10.38 J/min. For CRRT use, MP showed significant but limited discrimination (AUC = 0.624; 95% CI, 0.584-0.664; p < 0.001). Conclusions: In critically ill patients receiving IMV, higher MP remained associated with AKI after adjustment for measured covariates. The 10.38 J/min threshold is hypothesis-generating and requires external validation.
SN - 1010-660X
SN - 1648-9144
ER -