ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Exploring the Association of Mechanical Power with Mortality and Phenotypes among patients with Acute Respiratory Distress Syndrome : A Retrospective Analysis
Mingxing Fang 1,2,3
Qi Zhang 1,2
Na Liu 4
Fan Wang 5
Huiyong Wang 6,7
Renshuang Ding 2,7
Yan Li 1,2
Zhiyong Wang 1,2
Yan Li 7
1. Department of Critical Care Medicine, Hebei Medical University Third Hospital, Hebei, China
2. Critical Disease Data Analysis and Intelligent Diagnosis and Treatment Engineering Research Center of Hebei Province, Hebei Medical University Third Hospital, Hebei, China
3. Department of Emergency and Internal Medicine, The People’s Hospital of Tiemenguan, Tiemenguan, China
4. Department of Emergency, The Fourth Hospital of Hebei Medical University, Hebei, China
5. School of Public Health, Hebei Medical University, Hebei, China
6. Critical Disease Data Analysis and Intelligent Diagnosis and Treatment Engineering Research Ceter of Hebei Province, Hebei Medical University Third Hospital, Hebei, China
7. School of Information Science and Engineering, Hebei University of Science and Technology, Hebei, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract
Introduction: Mechanical power (MP) quantifies the energy delivered from a ventilator to the respiratory system and is a key contributor to ventilator-induced lung injury. This study evaluated the association between MP and mortality in patients with acute respiratory distress syndrome (ARDS), and examined whether this relationship differs across data-driven ARDS phenotypes. Methods: Patients with ARDS requiring invasive ventilation were identified from the MIMIC-IV database. The association between MP and mortality was assessed using logistic regression, Kaplan–Meier survival analysis, and Cox proportional hazards models. The optimal MP threshold was determined using maximally selected rank statistics. Unsupervised clustering was used to identify ARDS phenotypes and evaluate phenotype-specific responses to MP. Results: A total of 1333 patients were included. An MP <18.7 J/min was associated with significantly lower 28-day mortality. Among MP components, the elastic-dynamic component showed the strongest association with mortality; the elastic-static component had a weaker association, and the resistive component was not significant. Respiratory rate was the strongest predictor of mortality. Three phenotypes were identified. Phenotype I (mechanical stress-dominant): poor respiratory mechanics and the highest mortality. Phenotype II (oxygenation-preserved with mild inflammation): better oxygenation, less organ dysfunction, and the lowest mortality. Phenotype III (systemic hyperinflammation with metabolic dysregulation): significant laboratory abnormalities, strong association with high MP, and increased mortality. Discussion: High mechanical power (MP) was independently associated with increased mortality in patients with ARDS. An MP threshold of 18.7 J/min demonstrated prognostic relevance for mortality risk stratification, and the association between MP and outcomes varied across ARDS phenotypes, highlighting the potential value of phenotype-informed ventilation strategies.
Summary
Keywords
Acute Respiratory Distress Syndrome, consensus clustering analysis, Mechanical power, mechanical ventilation, Mortality
Received
15 September 2025
Accepted
17 February 2026
Copyright
© 2026 Fang, Zhang, Liu, Wang, Wang, Ding, Li, Wang and Li. 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: Mingxing Fang
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.