Mechanical power (MP) estimates the energy delivered to the lungs during ventilation. This study reviews pediatric research on MP and its association with ventilation duration and mortality.

According to the PRISMA guidelines, a systematic search was conducted in the databases Pubmed, Embase, Scopus, Web of Science, Lilacs, and Cochrane. A manual search was performed in the bibliography of the included studies and in the grey literature. All articles on mechanical power were included, and then studies focusing on the pediatric population were selected. The risk of bias was assessed using the Newcastle-Ottawa scale.

Nine articles were included. No randomized controlled trials were found. A total of 1769 children were included, of whom 1417 were diagnosed with acute respiratory distress syndrome (ARDS), while 148 had no evidence of lung injury. The median age ranged from 5.7 to 114 months, and 275 children died. MP values were found to be associated with increased mortality. Most studies utilized adaptations of the Gattinoni or Becher formulas. In children without lung pathology, average MP values were 3.93 ± 1.1 J/min. For children with ARDS, median MP values were 10 J/min in survivors and 15 J/min in non-survivors. Elevated MP values, particularly when assessed dynamically within the first 24 h of ventilation and adjusted for body weight, were consistently associated with increased mortality and, in some studies, prolonged ventilation duration.

Mechanical power can be measured in children on pressure-controlled ventilation, preferably adjusted for body weight. Further research is needed to define risk thresholds.