Association of Breathing Effort With Survival in Patients With Acute Respiratory Distress Syndrome.

IF 6 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Medicine Pub Date : 2025-08-04 DOI:10.1097/CCM.0000000000006797

Francisco José Parrilla-Gómez, Andrea Castellví-Font, Víctor Boutonnet, Andrés Parrilla-Gómez, Marta Antolín Terreros, Cristina Mestre Somoza, Marina Blanes Bravo, Paola Pratsobrerroca de la Rubia, Eva Martín-López, Santiago Marco, Olimpia Festa, Laurent J Brochard, Ewan C Goligher, Joan Ramon Masclans Enviz

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引用次数: 0

Abstract

Objectives: Invasive mechanical ventilation (IMV) is crucial for acute respiratory distress syndrome (ARDS) management, but mortality remains high. While spontaneous breathing is key to weaning, excessive respiratory effort may injure the lung and diaphragm. Most existing data on respiratory effort during IMV are based on brief periods of observation, potentially underestimating the burden of inappropriate efforts. This study aims to characterize the evolution of respiratory effort over time in ARDS patients and its relation to survival. We hypothesized that nonsurvivors would spend a greater proportion of time in the high-effort range during the active breathing phase compared with survivors.

Design, setting, and patients: In this prospective cohort study, we continuously recorded airway pressure, flow, esophageal, and gastric pressures in ARDS patients on mechanical ventilation during 7 days after the onset of spontaneous breathing. We analyzed physiologic respiratory effort variables, focusing on the proportion of time spent within defined effort ranges, and compared these data between ICU survivors and nonsurvivors. Statistical analysis was conducted using variance weighted methods to account for variability in the number of respiratory cycles analyzed per patient. This study is registered at ClinicalTrials.gov under identifier NCT06490523.

Interventions: None.

Measurements and main results: A total of 1,485,405 respiratory cycles were analyzed from 26 ARDS patients (19 survivors, seven nonsurvivors). Nonsurvivors spent significantly more time in high effort (12% vs. 3%; p = 0.006). In contrast, survivors spent more time in the moderate-effort range (50% vs. 5%; p < 0.001). The time spend with high dynamic transpulmonary driving pressure (> 25 cm H2O) was also significantly different between groups (32% survivors vs. 74% nonsurvivors; p = 0.001).

Conclusions: Patients who die of ARDS are more likely to be exposed to high respiratory effort for prolonged periods of time compared with survivors.

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急性呼吸窘迫综合征患者呼吸努力与生存的关系。

目的：有创机械通气（IMV）对急性呼吸窘迫综合征（ARDS）的治疗至关重要，但死亡率仍然很高。虽然自主呼吸是脱机的关键，但过度的呼吸努力可能会伤害肺和隔膜。大多数关于IMV期间呼吸努力的现有数据都是基于短暂的观察，可能低估了不适当努力的负担。本研究旨在描述ARDS患者呼吸力随时间的演变及其与生存的关系。我们假设，在主动呼吸阶段，与幸存者相比，非幸存者将花费更多的时间在高努力范围内。设计、环境和患者：在这项前瞻性队列研究中，我们连续记录机械通气的ARDS患者在自主呼吸开始后7天内的气道压力、流量、食管和胃压力。我们分析了生生性呼吸努力变量，重点关注在规定的努力范围内花费的时间比例，并比较了ICU幸存者和非幸存者之间的这些数据。采用方差加权方法进行统计分析，以解释每个患者分析的呼吸周期数的可变性。该研究已在ClinicalTrials.gov注册，识别码为NCT06490523。干预措施:没有。测量结果和主要结果：共分析了26例ARDS患者的1,485,405个呼吸周期（19例幸存者，7例非幸存者）。非幸存者花在高努力上的时间明显更多(12% vs. 3%；P = 0.006)。相比之下，幸存者在中等努力范围内花费的时间更多(50% vs. 5%；P < 0.001)。高动态跨肺驱动压（> 25 cm H2O）的时间在两组之间也有显著差异(32%的幸存者对74%的非幸存者；P = 0.001)。结论：与幸存者相比，死于ARDS的患者更有可能长时间暴露于高呼吸压力下。

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

Critical Care Medicine 医学-危重病医学

CiteScore

16.30

自引率

5.70%

发文量

728

审稿时长

2 months

期刊介绍： Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.