This study investigated how a stepwise increase in Positive End-Expiratory Pressure (PEEP) affects respiratory mechanics and mechanical power in mechanically ventilated adults.

Using an incremental titration strategy, researchers analyzed key metrics like static compliance, plateau pressure, driving pressure, and mechanical power (calculated using established formulas). The results showed that as PEEP levels increased, there was a progressive and significant rise in total mechanical power, and the elastic power components (total and static), accompanied by a decrease in respiratory system compliance.

Crucially, the study demonstrated that increasing PEEP levels significantly raises total mechanical power and its elastic components, particularly the static elastic power.

While mechanical power showed strong correlations with changes in Pplat (p < 0.001), dynamic elastic power, and driving pressure, the change in mechanical power correlated strongly only with the change in resistive power. The conclusion warns that the overall rise in mechanical power, driven by its elastic components, may occur "silently" without immediate, significant changes in driving pressure or compliance, suggesting a hidden risk of increased mechanical stress on the lungs even in the absence of primary lung disease.

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