Barbeta, EnricBarreiros, CláudiaForin, EdoardoGuzzardella, AmedeoMotos, AnnaFernández-Barat, LaiaCantón Bulnes, María LuisaTorres, AntoniCIBERESUCICOVID Project investigators (COV20/00110, ISCIII)2025-06-172025-06-172025-01-25Barbeta, E., Barreiros, C., Forin, E., Guzzardella, A., Motos, A., Fernández-Barat, L.,...,CIBERESUCICOVID Project investigators (COV20/00110, I. (2025). Mechanical power is not associated with mortality in COVID-19 mechanically ventilated patients. Annals of Intensive Care, 15 (1), 27. https://doi.org/10.1186/s13613-025-01430-6.2110-5820https://hdl.handle.net/11441/174426Background The relative contribution of the different components of mechanical power to mortality is a subject of debate and has not been studied in COVID-19. The aim of this study is to evaluate both the total and the relative impact of each of the components of mechanical power on mortality in a well-characterized cohort of patients with COVID-19-induced acute respiratory failure undergoing invasive mechanical ventilation. This is a secondary analysis of the CIBERESUCICOVID project, a multicenter observational cohort study including fifty Spanish intensive care units that included COVID-19 mechanically ventilated patients between February 2020 and December 2021. We examined the association between mechanical power and its components (elastic static, elastic dynamic, total elastic and resistive power) with 90-day mortality after adjusting for confounders in seven hundred ninety-nine patients with COVID-19-induced respiratory failure undergoing invasive mechanical ventilation. Results At the initiation of mechanical ventilation, the PaO2/FiO2 ratio was 106 (78; 150), ventilatory ratio was 1.69 (1.40; 2.05), and respiratory system compliance was 35.7 (29.2; 44.5) ml/cmH2O. Mechanical power at the initiation of mechanical ventilation was 24.3 (18.9; 29.6) J/min, showing no significant changes after three days. In multivariable regression analyses, mechanical power and its components were not associated with 90-day mortality at the start of mechanical ventilation. After three days, total elastic and elastic static power were associated with higher 90-day mortality, but this relationship was also found for positive end-expiratory pressure. Conclusions Neither mechanical power nor its components were independently associated with mortality in COVID‑ 19‑induced acute respiratory failure at the start of MV. Nevertheless, after three days, static elastic power and total elastic power were associated with lower odds of survival. Positive end‑expiratory pressure and plateau pressure, however, captured this risk in a similar manner.application/pdf11 p.engAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/Mechanical powerCOVID‑19Mechanical ventilationRespiratory failureinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/openAccesshttps://doi.org/10.1186/s13613-025-01430-6