Daily Ards Research Analysis
A double-blind randomized pilot trial found that inhaled solnatide did not improve ventilator-free days or survival in COVID-19-related ARDS, though it appeared safe. A registered exploratory RCT protocol will test video-based CBT plus respiratory biofeedback for post COVID-19 bodily distress. A case-based review underscores the diagnostic complexity of infective vs non-infective endocarditis in an ICU patient with influenza-related ARDS.
Summary
A double-blind randomized pilot trial found that inhaled solnatide did not improve ventilator-free days or survival in COVID-19-related ARDS, though it appeared safe. A registered exploratory RCT protocol will test video-based CBT plus respiratory biofeedback for post COVID-19 bodily distress. A case-based review underscores the diagnostic complexity of infective vs non-infective endocarditis in an ICU patient with influenza-related ARDS.
Research Themes
- ENaC-targeted therapy for pulmonary permeability edema in COVID-19 ARDS
- Psychological and respiratory biofeedback interventions for post COVID-19
- Diagnostic differentiation of infective vs non-infective endocarditis in critical care
Selected Articles
1. Efficacy of solnatide to treat pulmonary permeability edema in SARS-CoV-2 positive patients with moderate to severe ARDS: A randomized controlled pilot-trial.
In this double-blind RCT of 30 ventilated patients with COVID-19 ARDS, inhaled solnatide did not increase 28-day ventilator-free days or survival compared with placebo. Safety was acceptable with no treatment-related adverse events identified.
Impact: This is one of the few randomized, double-blind evaluations of an ENaC-targeted therapy for pulmonary permeability edema in ARDS, providing rigorous negative evidence and safety data.
Clinical Implications: Solnatide should not be expected to improve short-term liberation from ventilation or survival in COVID-19 ARDS, though its safety profile supports consideration for study in different phenotypes or earlier disease windows.
Key Findings
- No difference in 28-day ventilator-free days: median 0 in both solnatide and placebo groups (p=0.653).
- 28-day survival was 66.7% overall (73.3% solnatide vs 60% placebo); 60-day survival differences were minimal.
- No adverse events were deemed related to study drug; safety profile appeared acceptable.
Methodological Strengths
- Randomized, double-blind, placebo-controlled design
- Prospective registration (EudraCT 2020-001244-26)
Limitations
- Early trial termination with small sample size (n=30 of planned 40)
- COVID-19-specific ARDS may limit generalizability to non-COVID ARDS phenotypes
Future Directions: Larger, adequately powered trials should test ENaC-targeted strategies in carefully phenotyped ARDS, including non-COVID cohorts and timing earlier in disease.
2. Respiratory biofeedback and psycho-education for patients with post COVID- 19 symptoms and bodily distress: study protocol of the randomized, controlled explorative intervention trial POSITIV.
This protocol describes a randomized, controlled exploratory trial testing video-based group CBT plus mobile respiratory biofeedback versus treatment as usual for post COVID-19 condition with bodily distress disorder. The primary endpoint is change in self-efficacy; 60 participants will be enrolled and outcomes span psychological and somatic domains.
Impact: Addresses a major unmet need by rigorously testing a scalable, blended mind–body intervention for post COVID-19, with clear primary and secondary outcomes and trial registration.
Clinical Implications: If effective, video-based CBT (cognitive behavioral therapy) and respiratory biofeedback could offer accessible, non-pharmacologic management to improve self-efficacy and reduce symptom burden in post COVID-19.
Key Findings
- Randomized, controlled exploratory design with 60 participants (30 per arm).
- Intervention integrates 6-week video group CBT and 4-week mobile respiratory biofeedback.
- Primary outcome is change in self-efficacy; registered in DRKS (DRKS00030565).
Methodological Strengths
- Prospective trial registration and predefined outcomes
- Randomized controlled design with blended digital and physiologic intervention
Limitations
- Exploratory pilot scale may limit statistical power and generalizability
- Protocol paper; no clinical outcomes reported yet
Future Directions: If signals of efficacy emerge, scale to multicenter, adequately powered RCTs and explore mechanistic mediators (e.g., autonomic regulation, dyspnea perception).
3. Infective or Non-Infective Endocarditis: A Brief Literature Review Based on a Case Report.
This case report outlines a stepwise diagnostic evaluation of multi-valvular lesions in an ICU patient with influenza-related ARDS, addressing the differential between infective and non-infective endocarditis. It synthesizes key literature to guide clinical reasoning in complex critical care presentations.
Impact: Highlights a diagnostically challenging overlap of critical illness (influenza-related ARDS) and multi-valvular pathology, providing a structured framework informed by literature.
Clinical Implications: Encourages systematic echocardiographic assessment and careful differentiation of infective vs non-infective etiologies in ICU patients with valvular lesions and respiratory failure.
Key Findings
- ICU patient with influenza-related ARDS had multi-valvular lesions (aortic, mitral, tricuspid) on echocardiography.
- Case presentation follows a step-by-step diagnostic approach anchored to clinical questions.
- Narrative review summarizes literature on differentiating infective vs non-infective endocarditis in complex ICU contexts.
Methodological Strengths
- Structured, question-driven diagnostic framework
- Integration of case data with targeted literature review
Limitations
- Single-case report limits generalizability
- No comparative or outcome data to quantify diagnostic strategies
Future Directions: Prospective cohorts integrating echocardiography, microbiology, and inflammatory biomarkers could refine diagnostic algorithms for endocarditis in critically ill patients with respiratory failure.