Correlation between mechanical power and lung ultrasound score and association with clinical outcomes in acute respiratory distress syndrome

doi:10.5492/wjccm.119057

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World Journal of Critical Care Medicine

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2220-3141

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Crit Care Med. Sep 9, 2026; 15(3): 119057
Published online Sep 9, 2026. doi: 10.5492/wjccm.119057

Correlation between mechanical power and lung ultrasound score and association with clinical outcomes in acute respiratory distress syndrome

Ashok K Pannu, Ripudaman Sharma, Ankur Gupta, Harsimran Kaur, Anas Valiyaparambath, Revathi S Nair, Navneet Sharma, Prannoy G Mathen

Prannoy G Mathen, Navneet Sharma, Ankur Gupta, Ripudaman Sharma, Ashok K Pannu, Acute Care Emergency Medicine Unit, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India

Revathi S Nair, Department of Trauma and Emergency, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune 411018, India

Anas Valiyaparambath, Department of Anaesthesia and Intensive Care Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India

Harsimran Kaur, Department of Clinical Nursing, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India

Author contributions: Mathen PG, Sharma N, Nair RS, Valiyaparambath A, Kaur H, Gupta A, Sharma R, and Pannu AK collected the data; Mathen PG designed the research study; Pannu AK analyzed the data; Mathen PG and Pannu AK wrote the manuscript; all authors have read and approved the final manuscript.

AI contribution statement: Standard language-editing tools (e.g., Grammarly or similar software) may have been used for minor grammar correction and readability improvement. These tools did not contribute to scientific content, interpretation, or conclusions. All data-driven figures were generated from original study data by the authors. Some schematic or illustrative elements were prepared with the assistance of AI-based tools and were used solely for visual presentation. These did not contribute to the study data, analysis, or interpretation.

Institutional review board statement: This study was approved by the Medical Ethics Committee of the Postgraduate Institute of Medical Education and Research, approval No. IEC-INT/2023/DM-1123.

Informed consent statement: All study participants, or legally acceptable representatives, provided informed written consent before study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.

Data sharing statement: No additional data are available. De-identified individual participant data cannot be shared publicly owing to institutional ethics committee restrictions and patient confidentiality requirements.

Corresponding author: Ashok K Pannu, MD, Additional Professor, Acute Care Emergency Medicine Unit, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, 4^th Floor, F Block, Chandigarh 160012, India. gawaribacchi@gmail.com

Received: January 19, 2026
Revised: January 30, 2026
Accepted: February 25, 2026
Published online: September 9, 2026
Processing time: 216 Days and 1.6 Hours

Abstract

BACKGROUND

Mechanical power (MP) integrates tidal volume, airway pressures, flow, and respiratory rate into a single estimate of ventilatory energy delivery and serves as an integrative physiologic marker of ventilator-induced lung injury. Lung ultrasound score (LUS) is a bedside tool that quantifies lung aeration loss, reflecting the structural expression of lung injury in acute respiratory distress syndrome (ARDS). However, data correlating MP with LUS and clinically relevant outcomes in ARDS remain limited.

AIM

To explore whether MP is associated with lung ultrasound–derived aeration loss and clinical outcomes in moderate-to-severe ARDS.

METHODS

This prospective observational study enrolled adult patients with moderate-to-severe ARDS requiring invasive mechanical ventilation for more than 48 hours. MP and LUS were assessed at 0, 24, 48, and 72 hours. Their association was evaluated using Pearson correlation analysis. Associations between MP and 28-day mortality and weaning outcomes were analyzed using logistic regression and receiver operating characteristic curve analysis. Mean MP was defined as the arithmetic mean across the four time points.

RESULTS

Forty-four patients were included. MP was strongly correlated with LUS at baseline (r = 0.84, 95%CI: 0.72-0.91), 24 hours (r = 0.83, 95%CI: 0.71-0.91), 48 hours (r = 0.91, 95%CI: 0.85-0.95), and 72 hours (r = 0.93, 95%CI: 0.87-0.96) (all P < 0.001). In exploratory analyses, higher mean MP was associated with increased mortality [odds ratio (OR) = 2.11 per J/minute increase, 95%CI: 1.31-3.39] and demonstrated numerically higher area under the receiver operating characteristic curve than driving pressure (0.98, 95%CI: 0.94-1.00 vs 0.91, 95%CI: 0.82-0.98). Higher mean MP was also associated with difficult (OR = 2.20, 95%CI: 1.11-4.36) and prolonged weaning (OR = 1.61, 95%CI: 1.04-2.50).

CONCLUSION

MP parallels lung ultrasound-derived aeration loss in ARDS and demonstrates associations with mortality and adverse weaning, supporting its potential role as an integrative physiologic marker in individualized ventilatory management.

Keywords: Acute respiratory distress syndrome; Mechanical power; Lung ultrasound; Lung aeration loss; Ventilator-induced lung injury; Mechanical ventilation; Mortality; Weaning outcomes; Prognosis

Core Tip: This prospective observational study demonstrates a close association between mechanical power (MP), an integrative measure of ventilatory energy delivery, and lung aeration loss assessed by lung ultrasound score in patients with moderate-to-severe acute respiratory distress syndrome. Higher MP exposure was also associated with mortality and poor weaning outcomes. By linking ventilatory energy burden with bedside structural assessment of lung injury, this study highlights the potential value of combining MP and lung ultrasound to support physiologically informed and individualized ventilatory care.