Agreement Between Automated and Equation-Derived Mechanical Power in Pediatric Mechanical Ventilation

Abstract

Background:

Newer ventilators provide automated real-time mechanical power (MP_auto) measurements, but their accuracy in children across ventilation modes remains uncertain. We aimed to evaluate the agreement between the MP_auto measured on the Mindray SV-600 ventilator and the equation-derived MP (MP_calc) across two tidal volume (V_T) settings, ventilation modes, and predefined age groups in ventilated children.

Method:

In this prospective observational physiology study, consecutive mechanically ventilated children aged 1 month to 18 years were enrolled between August 2024 and May 2025 in a 30-bed pediatric ICU. MP_auto was compared with MP_calc, using comprehensive and surrogate equations during continuous mandatory volume-control (VC-CMV) and pressure-control (PC-CMV) modes at V_T of 6 and 8 mL/kg body weight. Subgroup analyses considered age and pediatric ARDS. In VC-CMV mode, MP was calculated with Gattinoni’s equation (MPVC_{comprehensive}) and Giosa’s equation (MPVC_surrogate). In PC-CMV mode, Van der Meijden’s equation (MPPC_{comprehensive}) and Becher’s equation (MPPC_surrogate) were used. Bland-Altman analyses evaluated agreement.

Results:

We included 147 children, with a median (interquartile range [IQR]) age of 49 (16–92) months, of whom 34 (23%) had pediatric ARDS. MP_auto showed strong agreement with MP_calc across ventilation modes and V_T settings. The agreement was highest in VC-CMV, with minimal bias (−0.12 to +0.011 J/min; intra-class correlation [ICC] ≥0.95) and >88% of observations within clinical limits of agreement. In PC-CMV, MP_auto demonstrated a systematic negative bias relative to MP_calc (minimal bias −1.23 to −0.62 J/min; ICC ≥0.92), with similar findings in subjects with pediatric ARDS. Age influenced agreement between MP_auto and MP_calc (slope −0.008 to −0.005), especially in PC-CMV mode (R² = 0.226–0.27). Pediatric ARDS status affected this relationship only in PC-CMV mode (P = .02 for MPPC_{comprehensive} and P = .006 for MPPC_surrogate).

Conclusion:

MP_auto demonstrated strong agreement with equation-derived MP during VC-CMV mode across different age groups. However, MP_auto showed a systematic negative bias relative to equation-derived MP in PC-CMV mode, particularly among younger children and those with pediatric ARDS.

Keywords

mechanical power mechanical power by geometric method mechanical power by comprehensive method mechanical power by surrogate equation mechanical power in pediatric ventilation automatically calculated mechanical power

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