The concept of mechanical power (MP) has emerged as a comprehensive indicator of ventilator-induced lung injury (VILI). It integrates the effects of tidal volume, airway pressures, respiratory rate, and flow. However, applying MP as a universal threshold (e.g., 12 J/min) across heterogeneous patients with acute respiratory distress syndrome (ARDS) may be inadequate. This review introduces the rheological model, which conceptualizes the lung as a viscoelastic body (i.e., one that exhibits both elastic and viscous properties), and applies it to ARDS ventilation. The rheological model may offer individualized MP thresholds. The potential benefits of adjusting MP based on ideal body weight (J/min/kg) are discussed and, more accurately, on static compliance (J/min/L). Static compliance could better reflect functional lung size, though clinical validation remains needed. Preliminary clinical and modeling evidence suggests that normalized MP correlates more closely with mortality than absolute MP and aligns with pulmonary stress–strain behavior. This normalization provides a more precise risk stratification and facilitates the easier setting of ventilation targets, particularly in patients with low compliance or abnormal body composition. This review clarifies definitions and consolidates evidence, highlights the clinical implications of rheology for lung-protective strategies. MP normalization within a lung-protective strategy could enhance the safety and efficacy of mechanical ventilation; however, clinical validation is still required. This review summarizes the theoretical foundations, supporting evidence, and clinical implications of this approach within the broader context of rheological modeling in ARDS.

Background: Invasive mechanical ventilation (MV) is central to paediatric intensive care practice; however, training structures vary across Europe. Although initiatives led by the European Society of Paediatric and Neonatal Intensive Care (ESPNIC), including its MV course, aim to address knowledge gaps and inconsistencies in training, disparities in educational exposure persist, and contemporary data on MV education are limited. Methods: A cross-sectional anonymous electronic survey assessing knowledge of MV was developed by two members of the ESPNIC MV faculty. Eligible participants were medical doctors in training working in paediatric intensive care units (PICUs) in the United Kingdom (UK) and Spain between January and March 2025. The questionnaire evaluated self-reported knowledge, objective understanding of key ventilatory concepts, and educational exposure. The primary outcome was the perceived sufficiency of MV education among respondents from the UK and Spain. Secondary outcomes included exposure to MV education, applicability of MV training to clinical practice, and the attitudes towards standardisation of MV training within paediatric critical care education. Data were analysed descriptively. Results: A total of 104 PICU doctors in training responded (UK, n = 39; Spain, n = 65). Denominators included non-responses per item. Among respondents, 10% (4/39) in the UK reported sufficient MV training, compared with 31% (20/65) in Spain. Attendance at formal MV teaching was reported by 54% (21/39) of UK respondents and 77% (50/65) of Spanish respondents. Suggested improvements to MV education included structured curriculum-integrated teaching, protected teaching time, simulation-based training, and improved access to funded courses. Conclusions: Considerable variability exists in MV education across both training systems, with persistent gaps in understanding of fundamental ventilatory concepts. This is reflected in the low levels of perceived sufficiency of MV training among PICU doctors in both the UK and Spain. Standardised, curriculum-integrated MV training incorporating simulation-based learning may improve both competence and confidence in paediatric ventilatory care.