Mechanical power in lung-protective ventilation: biomechanical rationale, calculation methods, and conceptual limitations

Introduction. Mechanical power (MP) has been proposed as an integrative measure of ventilatory load, yet the variety of available calculation methods and their variable accuracy across ventilation modes limit its clinical adoption.

The objective was to review and comparatively analyze mathematical models for calculating mechanical power (MP) of mechanical ventilation, to examine their physical foundations, limitations, and clinical applicability.

Materials and methods. Narrative literature review. A search was conducted in PubMed, Cochrane Library, Google Scholar, eLibrary databases covering the period 1990–2025. Publications addressing the geometric method of MP calculation, Gattinoni’s equation, surrogate formulas for volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV), formula validation, and clinical MP thresholds were analyzed.

Results. Two approaches to MP calculation were identified: the geometric method (reference standard, based on integrating the area under the pressure-volume curve) and surrogate algebraic equations derived from ventilator-displayed parameters. Gattinoni’s equation (2016) is derived from the equation of motion and accounts for elastic and resistive components of respiratory work. Surrogate formulas for VCV and PCV show acceptable accuracy under standard ventilation conditions (bias ~ 1 J/min); however, accuracy decreases with extreme ventilation parameters. According to experimental data, MP values above 12 J/min are associated with ventilator induced lung injury (diffuse edema). In clinical studies, values above 17 J/min were independently associated with increased hospital mortality.

Conclusion. The MP concept may be considered as an integrated measure of the energy load on the respiratory system. Existing surrogate formulas may be used for clinical risk stratification, provided that the limitations of each model are recognized and the approach is individualized according to patient anthropometry and functional lung status.

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