Factors influencing the transition phase in acute respiratory distress syndrome: an observational cohort study.

IF 5.5 1区医学 Q1 CRITICAL CARE MEDICINE

Annals of Intensive Care Pub Date : 2025-05-26 DOI:10.1186/s13613-025-01484-6

Anne-Fleur Haudebourg, Louise Chantelot, Safaa Nemlaghi, Luc Haudebourg, Pascale Labedade, Mohamed Ahmed Boujelben, Guillaume Voiriot, Armand Mekontso Dessap, Muriel Fartoukh, Guillaume Carteaux

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引用次数: 0

Abstract

Background: Protective ventilation during the acute phase of ARDS and weaning from mechanical ventilation are well-established in current guidelines. However, the intermediate transition phase between these stages remains poorly characterized.

Objectives: To describe the transition phase in moderate-to-severe ARDS and evaluate the factors associated with neuromuscular blockade (NMBA) weaning failure and pressure support ventilation (PSV) failure.

Methods: This bicentric observational cohort study included patients with moderate-to-severe ARDS requiring NMBA continuous infusion within 72 h post-intubation. The transition phase was defined as the 72 h following the first NMBA weaning attempt. The main endpoints were the rates of NMBA reintroduction and PSV failure. Secondary outcomes included predictive factors for NMBA weaning failure and PSV failure and the impact of tidal volume on patient outcomes.

Main results: A total of 196 patients were included. NMBA weaning failure occurred in 74 (38%) patients. COVID-19 (OR 3.98 [1.95-8.41], p < 0.001), pH (OR 0.50 [0.30-0.79], p = 0.004), PaO₂/FiO₂ ratio (OR 0.92 [0.87-0.97], p = 0.007), and high or low driving pressure before first NMBA weaning attempt (< 12 or ≥ 14 cmH₂O) (OR 2.77 [1.16-7.14], p = 0.027) were significantly associated with NMBA reintroduction. PSV was initiated in 147 (75%) patients, with a failure rate of 57%, occurring after a median of 9 h [6-24]. Tidal volume (OR 1.28 [1.06-1.56], p = 0.012) was significantly associated with PSV failure. During PSV, 43% of patients exhibited high tidal volumes (> 8 mL/kg PBW). NMBA weaning failure was associated with fewer ventilator-free days and increased mortality at day 28. PSV failure was associated with fewer ventilator-free days.

Conclusion: The transition phase represents a high-risk period in ARDS, with significant failure rates for NMBA weaning and PSV trials that may influence patient outcomes. The transition phase therefore represents a critical area for future research to optimize management during this vulnerable period.

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影响急性呼吸窘迫综合征过渡期的因素：一项观察性队列研究。

背景：在ARDS急性期的保护性通气和脱离机械通气在当前的指南中得到了完善。然而，这些阶段之间的中间过渡阶段的特征仍然很差。目的：描述中重度ARDS的过渡阶段，评估神经肌肉阻断（NMBA）脱机失败和压力支持通气（PSV）失败的相关因素。方法：这项双中心观察队列研究纳入了插管后72小时内需要NMBA持续输注的中重度ARDS患者。过渡阶段被定义为第一次NMBA断奶后的72小时。主要终点为NMBA再引入率和PSV失败率。次要结局包括NMBA脱机失败和PSV失败的预测因素以及潮气量对患者结局的影响。主要结果：共纳入196例患者。74例（38%）患者发生NMBA脱机失败。COVID-19 (OR 3.98 [1.95-8.41]， p 2/FiO2比（OR 0.92 [0.87-0.97], p = 0.007）和首次NMBA脱机前驾驶压力（2O）（OR 2.77 [1.16-7.14], p = 0.027）与NMBA重新引入显著相关。147例（75%）患者开始了PSV治疗，失败率为57%，中位时间为9小时[6-24]。潮气量（OR = 1.28 [1.06-1.56], p = 0.012）与PSV衰竭显著相关。在PSV期间，43%的患者表现出高潮气量（bb80 mL/kg PBW）。NMBA脱机失败与无呼吸机天数减少和第28天死亡率增加有关。PSV衰竭与较少的无呼吸机天数相关。结论：过渡期是ARDS的高危期，NMBA断奶和PSV试验的失败率很高，可能会影响患者的预后。因此，过渡阶段代表了未来研究的关键领域，以优化这一脆弱时期的管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Intensive Care CRITICAL CARE MEDICINE-

CiteScore

14.20

自引率

3.70%

发文量

107

审稿时长

13 weeks

期刊介绍： Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.