Respiratory failure & ventilation
Association of respiratory drive and effort with mortality and time to discharge in patients on mechanical ventilation in Canada: a longitudinal, prospective, registry-based cohort study
Authors' conclusion
In patients on mechanical ventilation, insufficient or excessive respiratory drive and effort were associated with higher ICU mortality and lower rate of ICU discharge, particularly when oxygenation was more severely impaired. Elevated respiratory effort exacerbated the effect of ventilator-delivered driving pressure on outcome.
Study context
- Population
- Adults on mechanical ventilation admitted to the medical-surgical intensive care unit (ICU) at Toronto General Hospital, June 25, 2019, to April 1, 2022
- Participants
- 1,186 adults
- Exposure
- Levels of respiratory drive, effort, ΔPL,dyn and ΔPaw,dyn
- Outcome
- Daily hazards of death in ICU or discharge alive from ICU (Cox models adjusted for changing severity of illness)
Methodological detailslongitudinal, single-centre registry
- Longitudinal
- Single-centre registry
Main finding
As reported in the abstract
- Died during follow-up
- 298 (25%)
- P0.1 and Pocc non-linearly associated with hazards of death and discharge alive
- p≤0.024
- PaO2:FiO2 ≤150 mm Hg: low and high P0.1 and Pocc associated with lower rate of ICU discharge; PaO2:FiO2 >150 mm Hg: higher P0.1 and Pocc associated with accelerated ICU discharge
- interaction p<0.0001
- High ΔPL,dyn associated with lower rate of ICU discharge, especially when PaO2:FiO2 <150 mm Hg
- p<0.0001
- Higher effort magnified association between ΔPaw,dyn and rate of discharge alive
- interaction p=0.0052
Observational data: associations, not effects.
Original publication
Association of respiratory drive and effort with mortality and time to discharge in patients on mechanical ventilation in Canada: a longitudinal, prospective, registry-based cohort study. Lancet Respir Med. Published 19 September 2025. doi:10.
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