ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
This article is part of the Research TopicAdvancements in Mechanical Ventilation: Understanding Physiology to Mitigate ComplicationsView all 14 articles
Pre-bronchoscopy Mechanical Ventilation Standardization and the Predominant Impact of KPC Resistance on ICU Outcomes Standardized Pre-Bronchoscopy Mechanical Power and KPC Resistance as Predictors of Mortality in Ventilated ICU Patients: A Retrospective Cohort Study
Provisionally accepted
KILLEN HAROLD BRIONES-CLAUDETT1*
Killen Briones Zamora2*
Mónica H. Briones-Claudett3María Antonieta Touriz Bonifaz4,5Anahí D. Briones-Zamora2Diana C Briones Marquez5
MIchelle Grunauer6- 1Universidad Internacional del Ecuador, Quito, Ecuador
- 2Universidad de Especialidades Espiritu Santo Facultad de Ciencias Medicas, Samborondon, Ecuador
- 3Intensive Care Unit. Babahoyo, Instituto Ecuatoriano de Seguridad Social, Quito, Ecuador
- 4Universidad Catolica de Santiago de Guayaquil Facultad de Ciencias Medicas, Guayaquil, Ecuador
- 5Universidad de Guayaquil, Guayaquil, Ecuador
- 6Universidad San Francisco de Quito, Quito, Ecuador
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Background: Mechanical power (MP) quantifies the energy delivered by the ventilator per unit time and is linked to ventilator-induced lung injury and mortality in mechanically ventilated patients. Its prognostic value before high-risk interventions such as fiberoptic bronchoscopy remains uncertain. Standardization of pre-procedural ventilator settings may enhance the reliability of respiratory mechanics and MP assessment. Methods: We conducted a retrospective, single-center cohort study of 30 ICU patients on invasive mechanical ventilation undergoing urgent bronchoscopy. A five-minute stabilization under volume-controlled ventilation with FiO₂ 1.0 and unchanged PEEP and respiratory rate was applied before scope insertion. Pre-procedure MP, gas exchange, and respiratory mechanics were recorded. The primary outcome was 28-day mortality. Logistic regression evaluated associations with clinical and microbiological predictors. Results: Median age was 66 years and 73% of patients were male. Median baseline MP was 13.6 J/min. Although MP ≥18 J/min was associated with impaired respiratory mechanics, it was not linked to mortality. In multivariable analysis, only Klebsiella pneumoniae carbapenemase (KPC) positivity independently predicted death (OR 14.6; 95% CI 1.8–116.5; p=0.011), whereas MP was non-interpretable. Overall mortality was 26.7%. Interpretation: In critically ill ventilated patients undergoing urgent bronchoscopy, baseline MP under standardized ventilatory conditions did not independently predict outcome. Instead, KPC positivity emerged as the predominant determinant of mortality. These findings underscore the prognostic dominance of microbiological resistance over transient physiologic parameters and highlight the need to integrate rapid resistance profiling with ventilatory monitoring for risk stratification in ICU bronchoscopy critical need to integrate rapid resistance profiling, such as multiplex PCR for resistance gene detection, alongside standardized ventilatory monitoring for early risk stratification and targeted therapeutic intervention in ICU bronchoscopy.
Keywords: Mechanical power, Fiberoptic bronchoscopy, mechanical ventilation, ICU – Intensice Intensive Care Unit, KPC, Mortality, Respiratory Mechanics
Received: 16 Sep 2025; Accepted: 30 Nov 2025.
Copyright: © 2025 BRIONES-CLAUDETT, Briones Zamora, Briones-Claudett, Touriz Bonifaz, Briones-Zamora, Briones Marquez and Grunauer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
KILLEN HAROLD BRIONES-CLAUDETT
Killen Briones Zamora
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