Daily Ards Research Analysis

BACKGROUND: ARDS is a heterogeneous syndrome involving different subphenotypes with different clinical features and different responses to treatment strategies. The prone position (PP) is an effective treatment for ARDS; however, whether the effects of prone positioning vary among ARDS patients with different subphenotypes remains unknown. OBJECTIVES: To evaluated the impact of PP on ventilation-perfusion matching(VQ matching) by contrast-enhanced Electrical impedance tomography (EIT) in ARDS patients with different subphenotypes. METHODS: This was a prospective, observational study at the medical ICU of Zhongda Hospital, Southeast University. ARDS patients undergoing mechanical ventilation were screened and allocated to different subphenotypes based on lung morphology (focal/non-focal) and D-dimer level (low/high D-dimer). EIT was used in the supine position and 3 h, 6 h, and 12 h after the PP during the first PP session. RESULTS: From July 1, 2021, to July 1, 2022, 25 patients were included in this study. 10 patients (40%) were focal ARDS, and 15 were non-focal ARDS based on baseline morphology. 12 patients (48%) were high D-dimer ARDS, and 13 were low D-dimer ARDS based on baseline D-dimer levels. PaO2/FiO2 increased significantly 3 h after prone positioning in focal ARDS patients (130.30[109.94-147.30] vs. 213.50[176.00-256.50] mmHg, p < 0.001), while the effect of improved oxygenation was not apparent until 6 h after prone positioning in non-focal ARDS patients (104.60[95.20-127.00] vs. 190.20[160.10-213.20] mm Hg, p < 0.001). VQ matching improved after 3 h in the prone position in the focal ARDS group (69.93 ± 6.69 vs. 78.22 ± 5.07, p = 0.006) but improved after only 6 h in the prone position in the non-focal ARDS group (67.32 ± 4.78 vs. 78.70 ± 5.93, p < 0.001). In ARDS patients with varying levels of D-dimer, increased PaO2/FiO2 (126.60[99.30-146.20] vs. 185.20[112.10-236.00] mmHg, p = 0.013) and improved VQ matching (67.60 ± 4.60 vs. 72.97 ± 6.48, p = 0.023) were observed at 3 h in the PP in patients with low D-dimer ARDS. In contrast, increased PaO2/FiO2(105.20[95.20-124.10] vs. 195.2[183.20-213.20], p < 0.001) and improved VQ matching (67.19 ± 6.70 vs. 72.50 ± 6.37, p < 0.001) were revealed only after 6 h in the prone position in high D-dimer ARDS patients. CONCLUSIONS: For moderate to severe ARDS patients, non-focal and high D-dimer ARDS patients need longer PP to improve oxygenation and VQmatching than the focal and low D-dimer patients. CLINICAL TRIAL REGISTRATION: This was a prospective, observational study registered in the Chinese Clinical Trial Registry (ChiCTR2200055442, https://www.chictr.org.cn/ ), on June 30, 2021.

Diffuse alveolar damage (DAD) is a pathological hallmark of severe interstitial lung diseases, such as acute respiratory distress syndrome (ARDS), and is linked to poor prognosis. Previously, we identified 14-3-3σ/stratifin (SFN) as a serum biomarker candidate for diagnosing DAD. To clarify the time-dependent relationship between SFN expression and DAD, we here investigated pathological and molecular changes in serum, bronchoalveolar lavage fluid (BALF), and lung tissue in an oleic acid (OA)-induced ARDS rat model. Acute alveolar edema was observed after OA administration, followed by alveolar epithelial cell proliferation and increased BALF and serum SFN levels. Proteomic analysis of lung tissue extracts revealed that proteins related to "inflammatory response" and "HIF-1 signaling," including plasminogen activator inhibitor-1, were markedly increased 3 h after acute lung injury, followed by a gradual decrease. Conversely, proteins associated with "cell cycle" and "p53 pathway," including SFN, showed a persistent increase starting at 3 h and peaking at 48 h. Western blotting and immunohistochemistry confirmed that SFN was expressed in a part of proliferated alveolar type-II cells, accompanied by p53 activation, an important event for differentiation into type-I cells. SFN may be a biomarker closely related to alveolar remodeling during the repair process after lung injury.

BACKGROUND: COVID-19 can cause severe acute respiratory distress syndrome or myocardial dysfunction requiring extracorporeal membrane oxygenation (ECMO). Whether comorbidities or sociodemographic factors influence outcomes in these patients is unclear. METHODS: Adult patients from the National Inpatient Sample dataset with COVID-19 pneumonia or non-COVID-19 pneumonia who underwent ECMO between 2016 and 2021 were included. Cohorts were matched in a 1:5 ratio using propensity scores. The primary outcome of interest was inpatient mortality; secondary outcomes included length of stay, total hospitalization costs, need for dialysis, rate of vascular complications, and discharge disposition. RESULTS: Weighted patient groups (COVID-19 pneumonia, 5680 patients; non-COVID-19 pneumonia, 430 patients) were identified. Mean (SD) age was 46.0 (11.2) years in the COVID-19 group, 45.1 (12.5) years in the non-COVID-19 group. After matching, unweighted groups (COVID-19 pneumonia, 1136 patients; non-COVID-19 pneumonia, 86 patients) were compared. Patients with COVID-19 pneumonia had higher mortality risk (odds ratio [OR], 1.98; 95% CI, 1.11-3.53; P = .02), longer stays (38.0 vs 28.5 days, P < .001), higher costs ($1 278 270 vs $967 866, P = .002), and less likelihood of discharge home (OR, 0.42; 95% CI, 0.21-0.85; P = .02) than patients with non-COVID-19 pneumonia. Vascular complication rate (OR, 0.77; 95% CI, 0.27-2.26; P = .64) and need for dialysis (OR, 1.01; 95% CI, 0.49-2.08; P = .97) did not differ between groups. CONCLUSIONS: Among patients undergoing ECMO, those with COVID-19 pneumonia had worse outcomes than those with non-COVID-19 pneumonia after adjustment for sociodemographic factors and comorbidities.