The effect of the respiratory rate on mechanical power and patient outcomes – a systematic review

Abstract

INTRODUCTION: Mechanical power (MP) is associated with worse clinical outcomes. Respiratory rate (RR) is a key component of MP. The aim of this systematic review was to assess whether, among mechanically ventilated adult ICU patients, a low versus high RR is associated with differences in MP, clinical outcomes and ventilation parameters. METHODS: A comprehensive systematic search in PubMed, Embase, Cochrane Central Register of Controlled Trials and Google Scholar was performed in January 2026. Studies were included if they reported on invasively ventilated adult patients in the ICU and evaluated RR in relation to MP or patient outcomes. RESULTS: 12 studies were included. Most studies involved patients with ARDS or COVID-19. Lower RR was associated with reduced MP across most studies. Studies using automated ventilation or protocolized RR adjustments showed the largest reductions in MP. Higher RR was associated with increased mortality in three studies. Reducing RR did not lead to significant changes in other ventilation parameters or gas exchange. CONCLUSION: Lowering RR is a promising strategy to reduce MP with minimal effects on gas exchange over short durations. RR may represent an underrecognized setting in lung-protective ventilation, but prospective studies are needed to confirm effects on clinical outcomes. STUDY REGISTRATION: The search strategy was registered at PROSPERO (registration number CRD420251240779).