{"id":1339,"date":"2026-03-14T16:57:29","date_gmt":"2026-03-14T16:57:29","guid":{"rendered":"https:\/\/perfusfind.com\/ic\/?p=1339"},"modified":"2026-03-14T16:57:29","modified_gmt":"2026-03-14T16:57:29","slug":"association-of-breathing-effort-with-survival-in-patients-with-acute-respiratory-distress-syndrome","status":"publish","type":"post","link":"https:\/\/perfusfind.com\/ic\/index.php\/2026\/03\/14\/association-of-breathing-effort-with-survival-in-patients-with-acute-respiratory-distress-syndrome\/","title":{"rendered":"Association of Breathing Effort With Survival in Patients With Acute Respiratory Distress Syndrome"},"content":{"rendered":"

Abstract<\/h3>\n

This multicenter prospective cohort study investigated whether breathing effort, estimated by esophageal pressure swing (\u0394Pes), is associated with survival in adults with acute hypoxemic respiratory failure (AHRF) receiving noninvasive respiratory support (NRS). Across 12 ICUs in Italy, 180 patients were enrolled. The study found that higher breathing effort\u2014particularly \u0394Pes >10 cmH\u2082O\u2014was independently associated with increased mortality, suggesting that monitoring and controlling excessive effort during NRS could be clinically important.<\/p>\n

\"\"<\/p>\n

Key Points<\/h3>\n
    \n
  1. Background and rationale<\/strong> – In AHRF, spontaneous breathing can be beneficial by maintaining diaphragm activity and improving oxygenation, but excessive effort may worsen lung injury via patient self-inflicted lung injury (P-SILI). Quantifying breathing effort in clinical practice is challenging, and its prognostic value during NRS is uncertain.<\/li>\n
  2. Objective<\/strong> – To assess the association between breathing effort, measured via \u0394Pes, and 30-day survival in AHRF patients managed with NRS (high-flow nasal oxygen [HFNO], continuous positive airway pressure [CPAP], or noninvasive ventilation [NIV]).<\/li>\n
  3. Methods<\/strong> – A prospective observational cohort design across 12 ICUs in Italy. Eligible patients had AHRF (PaO\u2082\/FiO\u2082 \u2264200 mmHg) and were initiated on NRS. \u0394Pes was measured within 3 hours of starting NRS using an esophageal balloon catheter during tidal breathing.<\/li>\n
  4. Exposure variable<\/strong> – Breathing effort quantified as \u0394Pes, with a threshold of >10 cmH\u2082O considered high effort, based on prior physiologic studies linking this level to injurious transpulmonary pressures.<\/li>\n
  5. Primary outcome<\/strong> – All-cause 30-day mortality.<\/li>\n
  6. Secondary outcomes –<\/strong> Intubation rates, ICU and hospital length of stay, ventilator-free days, and complications related to NRS.<\/li>\n
  7. Results \u2013 effort distribution –<\/strong> Median \u0394Pes was 10 cmH\u2082O (IQR 7\u201314). Forty-eight percent of patients had \u0394Pes >10 cmH\u2082O. Higher \u0394Pes correlated with lower PaO\u2082\/FiO\u2082, higher respiratory rate, and greater use of NIV.<\/li>\n
  8. Results\/outcomes<\/strong> – Mortality was significantly higher in the high-effort group (38%) compared with the low-effort group (15%). After adjusting for severity (SAPS II), PaO\u2082\/FiO\u2082, and NRS type, high \u0394Pes remained independently associated with increased mortality (adjusted HR ~2.3).<\/li>\n
  9. Physiologic interpretation<\/strong> – Excessive effort may exacerbate P-SILI through high transpulmonary pressures, regional overdistension, and increased negative intrathoracic swings, potentially worsening pulmonary edema.<\/li>\n
  10. Clinical implications<\/strong> – Routine monitoring of breathing effort\u2014using esophageal manometry or validated surrogates\u2014could help tailor NRS settings to mitigate P-SILI risk. Strategies may include sedation, switching to invasive ventilation, or adjusting PEEP and flow to reduce inspiratory drive.<\/li>\n<\/ol>\n

    Conclusion<\/h3>\n

    In AHRF patients receiving NRS, excessive spontaneous breathing effort (\u0394Pes >10 cmH\u2082O) is independently associated with higher mortality. These findings support integrating breathing effort monitoring into NRS management protocols to optimize outcomes and prevent P-SILI.<\/p>\n

    ACCESS FULL ARTICLE HERE<\/a><\/strong><\/p>\n

    \"\"<\/p>\n

    Discussion Questions<\/h3>\n
      \n
    1. How feasible is routine esophageal manometry in diverse ICU settings for monitoring effort during NRS?<\/li>\n
    2. What alternative noninvasive surrogates for \u0394Pes could reliably predict high-risk breathing effort?<\/li>\n
    3. Should high breathing effort during NRS be a formal criterion for early intubation to prevent P-SILI?<\/li>\n<\/ol>\n

       <\/p>\n

      Open Access<\/strong> This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:\/\/creativecommons.org\/licenses\/by\/4.0\/<\/strong><\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

      Abstract This multicenter prospective cohort study investigated whether breathing effort, estimated by esophageal pressure swing (\u0394Pes), is associated with survival in adults with acute hypoxemic respiratory failure (AHRF) receiving noninvasive respiratory support (NRS). Across 12 ICUs in Italy, 180 patients were enrolled. The study found that higher breathing effort\u2014particularly \u0394Pes >10 cmH\u2082O\u2014was independently associated with […]<\/p>\n","protected":false},"author":1,"featured_media":1346,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[4],"tags":[178,511],"class_list":["post-1339","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-respiratory","tag-acute-respiratory-distress-syndrome","tag-noninvasive-respiratory-support-nrs"],"yoast_head":"\nAssociation of Breathing Effort With Survival in Patients With Acute Respiratory Distress Syndrome - 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Across 12 ICUs in Italy, 180 patients were enrolled. The study found that higher breathing effort\u2014particularly \u0394Pes >10 cmH\u2082O\u2014was independently associated with…","_links":{"self":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts\/1339","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/comments?post=1339"}],"version-history":[{"count":1,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts\/1339\/revisions"}],"predecessor-version":[{"id":1347,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/posts\/1339\/revisions\/1347"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/media\/1346"}],"wp:attachment":[{"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/media?parent=1339"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/categories?post=1339"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/perfusfind.com\/ic\/index.php\/wp-json\/wp\/v2\/tags?post=1339"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}