Factors influencing the transition phase in acute respiratory distress syndrome: an observational cohort study
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 m...
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SpringerOpen
2025-05-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-025-01484-6 |
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| author | Anne-Fleur Haudebourg Louise Chantelot Safaa Nemlaghi Luc Haudebourg Pascale Labedade Mohamed Ahmed Boujelben Guillaume Voiriot Armand Mekontso Dessap Muriel Fartoukh Guillaume Carteaux |
| author_facet | Anne-Fleur Haudebourg Louise Chantelot Safaa Nemlaghi Luc Haudebourg Pascale Labedade Mohamed Ahmed Boujelben Guillaume Voiriot Armand Mekontso Dessap Muriel Fartoukh Guillaume Carteaux |
| author_sort | Anne-Fleur Haudebourg |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-700570280d134ffc8e6e394e00d496f7 |
| institution | DOAJ |
| issn | 2110-5820 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj-art-700570280d134ffc8e6e394e00d496f72025-08-20T03:22:08ZengSpringerOpenAnnals of Intensive Care2110-58202025-05-0115111210.1186/s13613-025-01484-6Factors influencing the transition phase in acute respiratory distress syndrome: an observational cohort studyAnne-Fleur Haudebourg0Louise Chantelot1Safaa Nemlaghi2Luc Haudebourg3Pascale Labedade4Mohamed Ahmed Boujelben5Guillaume Voiriot6Armand Mekontso Dessap7Muriel Fartoukh8Guillaume Carteaux9Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert ChenevierService de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert ChenevierService de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert ChenevierService de Réanimation médicale et infectieuse, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude BernardService de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert ChenevierService de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert ChenevierService de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital TenonService de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert ChenevierService de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital TenonService de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor-Albert ChenevierAbstract 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.https://doi.org/10.1186/s13613-025-01484-6Mechanical ventilationRespiratory mechanicsAcute respiratory distress syndromeProtective ventilation |
| spellingShingle | Anne-Fleur Haudebourg Louise Chantelot Safaa Nemlaghi Luc Haudebourg Pascale Labedade Mohamed Ahmed Boujelben Guillaume Voiriot Armand Mekontso Dessap Muriel Fartoukh Guillaume Carteaux Factors influencing the transition phase in acute respiratory distress syndrome: an observational cohort study Annals of Intensive Care Mechanical ventilation Respiratory mechanics Acute respiratory distress syndrome Protective ventilation |
| title | Factors influencing the transition phase in acute respiratory distress syndrome: an observational cohort study |
| title_full | Factors influencing the transition phase in acute respiratory distress syndrome: an observational cohort study |
| title_fullStr | Factors influencing the transition phase in acute respiratory distress syndrome: an observational cohort study |
| title_full_unstemmed | Factors influencing the transition phase in acute respiratory distress syndrome: an observational cohort study |
| title_short | Factors influencing the transition phase in acute respiratory distress syndrome: an observational cohort study |
| title_sort | factors influencing the transition phase in acute respiratory distress syndrome an observational cohort study |
| topic | Mechanical ventilation Respiratory mechanics Acute respiratory distress syndrome Protective ventilation |
| url | https://doi.org/10.1186/s13613-025-01484-6 |
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