Respiratory failure & ventilation
Factors influencing the transition phase in acute respiratory distress syndrome: an observational cohort study
Authors' 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.
Study context
- Population
- Patients with moderate-to-severe ARDS requiring neuromuscular blockade (NMBA) continuous infusion within 72 h post-intubation
- Participants
- 196 patients
- Outcome
- Rates of NMBA reintroduction and PSV failure during the transition phase (72 h following the first NMBA weaning attempt)
Methodological detailsbicentric
- Bicentric
Main finding
As reported in the abstract
NMBA weaning failure
74
38%
Pressure support ventilation (PSV) initiated
147
75%
PSV failure rate
57%
Median time to PSV failure
9 h
6–24
Observational data: associations, not effects.
Secondary outcomes
Factors associated with NMBA reintroduction
| OR (CI) | P value | ||
|---|---|---|---|
| COVID-19 | 3.98 (1.95–8.41) | P < 0.001 | |
| pH | 0.50 (0.30–0.79) | P = 0.004 | |
| PaO2/FiO2 ratio | 0.92 (0.87–0.97) | P = 0.007 | |
| High or low driving pressure (< 12 or ≥ 14 cmH2O) before first NMBA weaning attempt | 2.77 (1.16–7.14) | P = 0.027 | |
| 0.10.31310Odds ratio (log scale) |
Factors associated with PSV failure
| OR (CI) | P value | ||
|---|---|---|---|
| Tidal volume | 1.28 (1.06–1.56) | P = 0.012 | |
| 0.512Odds ratio (log scale) |
- Factors associated with PSV failure — High tidal volumes (> 8 mL/kg PBW) during PSV
- 43%
Outcomes associated with NMBA weaning failure and PSV failure · day 28
- NMBA weaning failure associated with fewer ventilator-free days and increased mortality at day 28
- PSV failure associated with fewer ventilator-free days
Original publication
Factors influencing the transition phase in acute respiratory distress syndrome: an observational cohort study. Ann Intensive Care. Published 26 May 2025. doi:10.
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