340 - Mechanical power and lung aeration in invasively ventilated neonates: first reference data

Publication Number: 340.5860

Sofia De La Rubia-Ortega, APHP-Paris Saclay University, Paris, Ile-de-France, France; Barbara Loi, Antoine Beclere Medical Center - Paris Saclay University Hospitals, Paris, Ile-de-France, France; Costanza R. Neri, APHP Paris-Saclay University, Paris, Ile-de-France, France; Daniele De Luca, APHP - Paris Saclay University, Paris, Ile-de-France, France

Background: Mechanical power (MP) describes the energy delivered by the ventilator and, in invasively ventilated adults, has been associated with mortality and other relevant clinical outcomes. The pathobiological link would be represented by the delivery of high energy that would contribute to ventilator-induced lung injury. No data are available about MP in neonates.

Objective: To describe MP in neonates ventilated for different types of lung injury and in control neonates with no lung disease (NLD). To analyze the relationship correlation between lung aeration and MP.

Design/Methods: Neonates with RDS (n=16), NARDS (n=12, defined according to Montreux definition [1]), and evolving BPD (n=10, as previously defined [2]) were studied together with 21 NLD infants (as previously defined [3]). MP was calculated using linear, Becher’s, van der Meijden’s and simplified Becher’s equations [4] and indexed to the birthweight. Calculations were only done in ideal conditions with leaks < 5% and using compliance and resistances as previously described.[5] At the same time of MP calculation, lung aeration has been assessed with the neonatal lung ultrasound score.[6]

Results: Studied neonates had mean gestational age and birthweight 32 (5.8)w and 1914 (1126)gr, respectively. On the whole population MP spans from a min of 0.04 J/Kg to a max of 1.8 J/Kg with the 4 estimating equations. ANOVA (overall p< 0.001) shows that infants ventilated for BPD receive a higher MP than those ventilated for RDS or NARDS or NLD (all Sidak post hoc p< 0.01, Fig.1). MP is directly correlated with ultrasound assessed lung aeration (Linear model: =0.29, p=0.025; Becher’s model: =0.36, p=0.005; van der Meijden’s model: =0.41, p=0.001; Simplified Becher’s model: =0.39, p=0.002).

Conclusion(s): Neonatal reference values of MP are given. Invasively ventilated neonates are subjected to different MP depending on the underlying lung injury. Lower lung aeration (i.e. less aerated lung tissue) is associated with greater MP.


References:
1. De Luca D. Lancet Resp Med 2017
2. Loi B. Anesthesiology 2024
3. Biasucci D. Respir Res 2022
4. Trinkle C. Intensive Care Med Exp 2022
5. De Luca D. Intensive Care Med 2012
6. Brat R. JAMA Pediatr 2015

Mechanical power in neonates ventilated for different types of lung injury.
Columns and T-bars represent mean and standard deviations, respectively. Light blue, red, green and violet represent mechanical power values estimated according to different equations (see legend and 4. Trinkle C. Intensive Care Med Exp 2022). Mechanical power is index to birth weight. Abbreviations: BPD: bronchopulmonary dysplasia, NARDS: neonatal acute respiratory distress syndrome, RDS: respiratory distress syndrome (i.e. hyaline membrane disease due to primary surfactant deficiency).