Mechanical power (MP) as a predictor of outcome in patients with moderate to severe traumatic brain injury (TBI): a prospective observational study

There are different conditions for admission to neuro-critical care (NCC). The most common reason is acute brain injury, which includes traumatic brain injury, subarachnoid hemorrhage, and intracranial hemorrhage. The altered level of sensorium of these individuals necessitates intubation and invasive mechanical ventilation to prevent aspiration and life-threatening consequences, such as hypoxia and hypercapnia. Moreover, patients are also at a high risk of respiratory complications and mortality during their stay in the NCC. However, invasive mechanical ventilation is also associated with ventilator induced lung injury(VILI). There is experimental evidence showing that VILI is influenced with every aspect of ventilator setting. Thus, we need to monitor a number of key parameters to ensure that mechanical ventilation do not lead to VILI such as low tidal volume, high positive end expiratory pressure (PEEP), limited plateau pressure and driving pressure. Mechanical power (MP) as calculated by combination of tidal volume, PEEP, plateau pressure, peak inspiratory pressure and respiratory rate is proposed to better capture the total energy delivered to lung parenchyma and risk of VILI. Therefore, it can be presumed that  MP may be better than any individual parameter in evaluating the prevalence of respiratory complications and mortality. However, there are only few investigations that have determined the connection between MP and outcome in neuro-critical patients.  This study is aimed to determine the predictive relevance of mechanical power in clinical outcomes of neuro-critical patients.