Dmitriy S. Kodatskiy, D.V. Marshalov, Kirill A. Sofronov, М. В. Кецкало, I. Yu. Sholin
INTRODUCTION: Mechanical power (MP) does not account for aerated lung volume, potentially limiting its accuracy as a marker of ventilator-induced lung injury (VILI). In obese patients undergoing laparoscopic surgery, ventilation power density (VPD) may offer a more reliable predictor of postoperative pulmonary complications (PPCs). OBJECTIVE: To validate the calculation of ventilation power density (mechanical power indexed to the aerated lung volume) and to evaluate its prognostic value for PPCs in obese women undergoing laparoscopic pelvic surgery. MATERIALS AND METHODS: This retrospective cohort study included 64 women (age 35–58 years, ASA II-III, body mass index (BMI) ≥ 30 kg/m²). MP was calculated using the volume-controlled ventilation formula by L. Gattinoni et al. VPD was derived as MP divided by aerated lung volume, the latter computed as: RV + Cstat × PEEP + 0.5 × VT, where RV — residual volume, Cstat — static respiratory system compliance, PEEP — positive end-expiratory pressure, VT — volume tidal). The primary endpoint was PPC occurrence within 48 h postoperatively. ROC curve analysis and logistic regression were performed. RESULTS: PPCs occurred in 18 patients (28.1 %). VPD was significantly higher in the PPC group (11.2 ± 1.6 vs 8.7 ± 2.0 J·L−1·min−1; p < 0.001). The area under the ROC curve (AUC) for VPD was 0.864 (95 % CI 0.762–0.949), significantly outperforming MP (AUC 0.588; DeLong p < 0.001). An optimal VPD threshold of ≥ 9.9 J·L−1·min−1 yielded 88.9 % sensitivity and 76.1 % specificity. Each 1 J·L−1·min−1 increase in VPD was associated with higher PPC risk (odds ratio [OR] 2.256; 95 % CI 1.43–3.57; p = 0.04). CONCLUSIONS: Ventilation power density is a superior predictor of PPCs compared with absolute MP, with a clinically relevant threshold of ≥ 9.9 J·L−1·min−1. These findings may inform future strategies for personalized intraoperative ventilation management, pending prospective validation.