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<p>Mechanical power (MP) is increasingly recognized as a unifying variable that encapsulates ventilator-derived factors contributing to ventilator-induced lung injury. However, its clinical application remains limited by several challenges, including the lack of accessible real-time MP monitoring. This study aims to demonstrate the feasibility and safety of an electronic health record-integrated, MP-guided, and respiratory therapist (RT)-driven lung-protective ventilation (LPV) protocol (<i>VentCoach</i>). Single-center, single-blinded, randomized controlled feasibility trial utilizing block randomization to assign participants to either the standard care or <i>VentCoach</i> arm. Adult patients with acute hypoxemic and/or hypercapnic respiratory failure requiring intubation, admitted to medical or mixed medical-surgical ICUs at a tertiary care center in Rochester, Minnesota, were included in the study. The standard care arm received RT-driven lung-protective ventilation (LPV). The <i>VentCoach</i> arm received MP-guided adjustments to maintain mechanical power &lt; 12&#xa0;J/min while ensuring adequate gas exchange. Seventeen patients (<i>n</i> = 9 standard care, <i>n</i> = 8 <i>VentCoach</i>) were enrolled, demonstrating the feasibility of <i>VentCoach</i> without adverse events or workflow disruptions. No significant differences were observed in mortality, extubation time, dyssynchrony, or the use of sedation, analgesia, neuromuscular blockade, or vasoactive agents. The <i>VentCoach</i> group showed trends toward lower sedation requirements (−&#xa0;25.9&#xa0;mg/hour vs. +18.1&#xa0;mg/hour, <i>p</i> = 0.09) and greater reduction in mechanical power over 24&#xa0;h (−&#xa0;2.0&#xa0;J/min vs. +&#xa0;0.6&#xa0;J/min, <i>p</i> = 0.40), although these differences were not statistically significant. This feasibility study demonstrated practical implementation of the <i>VentCoach</i> protocol in a critical care setting, with no protocol-related adverse events or workflow disruptions in this limited cohort. While non-inferiority to standard lung-protective ventilation was observed, relationships between MP thresholds and clinical outcomes remain uncertain; directional signals support further study. Larger trials are needed to evaluate safety, MP reduction, and patient-centered outcomes (ClinicalTrials.gov Identifier: NCT07294768, Registration Date and Last Public Release: 12/08/2025).</p>

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Mechanical power guided lung protective ventilation in acute respiratory failure using the VentCoach approach

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月18日

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  • C. Zheng,
  • S. W. Abdulla,
  • P. R. Bauer,
  • P. R. M. Rocco,
  • J. J. Marini,
  • R. A. Oeckler,
  • G. A. Cortes-Puentes

摘要

Mechanical power (MP) is increasingly recognized as a unifying variable that encapsulates ventilator-derived factors contributing to ventilator-induced lung injury. However, its clinical application remains limited by several challenges, including the lack of accessible real-time MP monitoring. This study aims to demonstrate the feasibility and safety of an electronic health record-integrated, MP-guided, and respiratory therapist (RT)-driven lung-protective ventilation (LPV) protocol (VentCoach). Single-center, single-blinded, randomized controlled feasibility trial utilizing block randomization to assign participants to either the standard care or VentCoach arm. Adult patients with acute hypoxemic and/or hypercapnic respiratory failure requiring intubation, admitted to medical or mixed medical-surgical ICUs at a tertiary care center in Rochester, Minnesota, were included in the study. The standard care arm received RT-driven lung-protective ventilation (LPV). The VentCoach arm received MP-guided adjustments to maintain mechanical power < 12 J/min while ensuring adequate gas exchange. Seventeen patients (n = 9 standard care, n = 8 VentCoach) were enrolled, demonstrating the feasibility of VentCoach without adverse events or workflow disruptions. No significant differences were observed in mortality, extubation time, dyssynchrony, or the use of sedation, analgesia, neuromuscular blockade, or vasoactive agents. The VentCoach group showed trends toward lower sedation requirements (− 25.9 mg/hour vs. +18.1 mg/hour, p = 0.09) and greater reduction in mechanical power over 24 h (− 2.0 J/min vs. + 0.6 J/min, p = 0.40), although these differences were not statistically significant. This feasibility study demonstrated practical implementation of the VentCoach protocol in a critical care setting, with no protocol-related adverse events or workflow disruptions in this limited cohort. While non-inferiority to standard lung-protective ventilation was observed, relationships between MP thresholds and clinical outcomes remain uncertain; directional signals support further study. Larger trials are needed to evaluate safety, MP reduction, and patient-centered outcomes (ClinicalTrials.gov Identifier: NCT07294768, Registration Date and Last Public Release: 12/08/2025).