PSMA2 and acute respiratory distress syndrome: By contrast, under extracorporeal membrane oxygenation (ECMO), 30% of the patients do not recover quickly and cannot withstand spontaneous breathing trials,36 with inflammation as the limiting factor.36 The high respiratory drive observed in COVID ARDS requires stringent normothermia (35 < Θ < 36 °C) and high doses of alpha-2 agonist.37 When major metabolic acidosis occurs (e.g. abdominal sepsis38), a longer interval before considering a spontaneous breathing trial is required.