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 20 articles
Adjusting Inspiratory Rise Time Alters Mechanical Power in Acute Respiratory Distress Syndrome: Opposing Effects in Pressure-Controlled and Volume-Controlled Ventilation Modes
Provisionally accepted
- 1Basaksehir Cam and Sakura City Hospital, Istanbul, Türkiye
- 2TC Saglik Bakanligi Bakirkoy Dr Sadi Konuk Egitim ve Arastirma Hastanesi, Bakırköy, Türkiye
- 3Independent Software Developer, Antalya, Türkiye
- 4Mardin Research and Training Hospital, Mardin, Türkiye
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Background: Mechanical power (MP), a predictor of ventilator-induced lung injury (VILI), is influenced by ventilatory parameters such as inspiratory rise time (Tslope). While Tslope affects the flow profile, its impact on MP in acute respiratory distress syndrome (ARDS) has not been thoroughly studied, particularly using the geometric method. Methods: In this prospective observational study, 30 deeply sedated and paralyzed ARDS patients were ventilated in both volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) modes using a Maquet Servo-u ventilator. At inspiratory-to-expiratory (I:E) ratios of 1:2 and 1:1, Tslope was adjusted from 5% to 15%, and pressure–volume (P–V) loop screenshots were captured. Geometric mechanical power (MPtotal) was calculated based on the area enclosed by the P–V loops. A total of 720 images were analyzed. Results: In VCV mode, increasing Tslope from 5% to 15% led to a statistically significant increase in MPtotal: 0.8 J/min (5%) at I:E 1:2 and 0.1 J/min (1%) at I:E 1:1. Conversely, in PCV mode, Tslope prolongation resulted in a significant decrease in MPtotal: 1.8 J/min (12.5%) at I:E 1:2 and 1 J/min (7%) at I:E 1:1. No intrinsic PEEP was detected. Conclusion: Modifying Tslope alters MPtotal in opposing directions in PCV and VCV modes. In VCV, prolonging Tslope from 5% to 15% increased MP, whereas increasing the I:E ratio from 1:2 to 1:1 reduced MP. In PCV, prolongation of Tslope from 5% to 15% decreased MP by more than 1 J/min, and changes in the I:E ratio exerted minimal effects on MP.
Keywords: Acute Respiratory Distress Syndrome, inspiratory rise time, inspiratory-to-expiratory ratio, Mechanical ventilators, Tslope, Ventilator-Induced Lung Injury
Received: 17 Nov 2025; Accepted: 27 Jan 2026.
Copyright: © 2026 Tontu, Rahimi, Çelik, Tontu, Cukurova and Asar. 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: Furkan Tontu
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