The Association Between Mechanical Power and Mortality in Critically Ill Patients Receiving Invasive Mechanical Ventilation: A Systematic Review and Meta-Analysis

Objectives: To investigate the association between mechanical power and mortality in adult critically ill patients receiving invasive mechanical ventilation. Data Sources: We conducted a systematic search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials on August 12, 2025. Study Selection: We included studies comparing mechanical power between survivors and nonsurvivors or reporting adjusted mortality estimates in adult critically ill patients receiving invasive mechanical ventilation. Data Extraction: Two reviewers independently extracted study characteristics, ventilator variables, and mortality outcomes. Data Synthesis: Pooled mean differences (MDs) were calculated using inverse-variance random-effects models. Secondary analyses evaluated mechanical power normalized to predicted body weight and respiratory system compliance. Adjusted odds ratios (AORs) and adjusted hazard ratios (AHRs) for mortality per 1 J/min increase in mechanical power were synthesized separately using generic inverse-variance random-effects models. A total of 34 studies met inclusion criteria and were included in the meta-analyses. Mechanical power was higher in nonsurvivors than survivors (MD, 1.91 J/min; 95% CI, 1.30–2.51 J/min). Mechanical power normalized to predicted body weight (MD, 0.06 J/min/kg; 95% CI, 0.04–0.08 J/min/kg) and normalized to respiratory system compliance (MD, 0.28 J/min/mL/cm H 2 O; 95% CI, 0.10–0.45 J/min/mL/cm H 2 O) were also higher among nonsurvivors. Mechanical power was independently associated with mortality, with pooled AOR (1.04 per 1 J/min increase; 95% CI, 1.03–1.06 per 1 J/min increase) and pooled AHR (1.03; 95% CI, 1.00–1.07). A mechanical power threshold older than 17 J/min was associated with greater mortality (odds ratio, 1.60; 95% CI, 1.34–1.91). Conclusions: Higher mechanical power was consistently associated with increased mortality in invasively ventilated adults. Mechanical power may serve as a clinically relevant marker of ergotrauma; however, whether interventions that reduce mechanical power improve outcomes requires prospective investigation.