Abstract
Mechanical power (MP) is increasingly recognized as a unifying variable that encapsulates ventilator-derived factors contributing to ventilator-induced lung injury. However, its clinical application remains limited by several challenges, including the lack of accessible real-time MP monitoring. This study aims to demonstrate the feasibility and safety of an electronic health record-integrated, MP-guided, and respiratory therapist (RT)-driven lung-protective ventilation (LPV) protocol (VentCoach). Single-center, single-blinded, randomized controlled feasibility trial utilizing block randomization to assign participants to either the standard care or VentCoach arm. Adult patients with acute hypoxemic and/or hypercapnic respiratory failure requiring intubation, admitted to medical or mixed medical-surgical ICUs at a tertiary care center in Rochester, Minnesota, were included in the study. The standard care arm received RT-driven lung-protective ventilation (LPV). The VentCoach arm received MP-guided adjustments to maintain mechanical power < 12 J/min while ensuring adequate gas exchange. Seventeen patients (n = 9 standard care, n = 8 VentCoach) were enrolled, demonstrating the feasibility of VentCoach without adverse events or workflow disruptions. No significant differences were observed in mortality, extubation time, dyssynchrony, or the use of sedation, analgesia, neuromuscular blockade, or vasoactive agents. The VentCoach group showed trends toward lower sedation requirements (− 25.9 mg/hour vs. +18.1 mg/hour, p = 0.09) and greater reduction in mechanical power over 24 h (− 2.0 J/min vs. + 0.6 J/min, p = 0.40), although these differences were not statistically significant. This feasibility study demonstrated practical implementation of the VentCoach protocol in a critical care setting, with no protocol-related adverse events or workflow disruptions in this limited cohort. While non-inferiority to standard lung-protective ventilation was observed, relationships between MP thresholds and clinical outcomes remain uncertain; directional signals support further study. Larger trials are needed to evaluate safety, MP reduction, and patient-centered outcomes (ClinicalTrials.gov Identifier: NCT07294768, Registration Date and Last Public Release: 12/08/2025).
Data availability
The datasets generated and/or analyzed during the current study are not publicly available due to patient privacy and confidentiality considerations, but are available from the corresponding author on reasonable request (subject to institutional approvals and applicable data-use requirements).
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Acknowledgements
We would like to express our gratitude to Liu, Emily, M.S., for her invaluable contributions to the statistical analysis in this study. Her expertise and guidance were instrumental in ensuring the rigor and accuracy of our data analysis. Her efforts have greatly enhanced the overall quality and reliability of this work.
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Mayo Clinic Critical Care Research Subcommittee.
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C.Z.Z. and S.W.A. collected and analyzed the data and drafted the initial version of the manuscript. G.A.C.-P. conceived the study, supervised data collection and analysis, and critically revised the manuscript for important content. P.R.B. and R.A.O. contributed to study design, interpretation of data, and manuscript revision. P.R.M.R. and J.J.M. provided conceptual guidance, contributed to interpretation of findings, and critically reviewed the manuscript. All authors reviewed and approved the final version of the manuscript.
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Zheng, C., Abdulla, S.W., Bauer, P.R. et al. Mechanical power guided lung protective ventilation in acute respiratory failure using the VentCoach approach. Sci Rep (2026). https://doi.org/10.1038/s41598-026-40389-7
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DOI: https://doi.org/10.1038/s41598-026-40389-7
