Daily Ards Research Analysis
A bicentric cohort study defines a high-risk “transition phase” in ARDS, showing 38% neuromuscular blockade weaning failure and identifying COVID-19 and acidosis as key predictors. A case-control glycomics study in neonatal RDS reveals distinct IgG N-glycosylation signatures and a diagnostic model with AUC 0.90. A nationwide Spanish registry quantifies the added ICU use, ventilation, mortality, and costs when COVID-19 is present at childbirth.
Summary
A bicentric cohort study defines a high-risk “transition phase” in ARDS, showing 38% neuromuscular blockade weaning failure and identifying COVID-19 and acidosis as key predictors. A case-control glycomics study in neonatal RDS reveals distinct IgG N-glycosylation signatures and a diagnostic model with AUC 0.90. A nationwide Spanish registry quantifies the added ICU use, ventilation, mortality, and costs when COVID-19 is present at childbirth.
Research Themes
- Management of the ARDS transition phase (NMBA weaning and PSV)
- Biomarker discovery via IgG N-glycomics for neonatal RDS
- Population-level impacts of COVID-19 at childbirth on critical care and costs
Selected Articles
1. Factors influencing the transition phase in acute respiratory distress syndrome: an observational cohort study.
In a bicentric cohort of 196 moderate-to-severe ARDS patients, 38% experienced NMBA weaning failure during the 72-hour transition phase after the first weaning attempt. COVID-19 (OR 3.98) and lower pH (OR 0.50) were associated with failure, underscoring this period as high risk with implications for ventilatory strategy and monitoring.
Impact: This study operationalizes and quantifies the under-defined ARDS transition phase, identifying concrete predictors of failure that can be targeted to improve care. It highlights a vulnerable window that is amenable to protocolization and prospective trials.
Clinical Implications: Clinicians should anticipate higher failure risk within 72 hours after initial NMBA weaning, especially in COVID-19 and acidemic patients. Strategies include careful titration of sedation/ventilatory support, readiness for NMBA reintroduction, and close monitoring during early PSV trials.
Key Findings
- NMBA weaning failure occurred in 38% (74/196) during the 72-hour transition phase.
- COVID-19 was strongly associated with NMBA weaning failure (OR 3.98 [1.95–8.41], p<0.001).
- Blood pH was associated with failure risk (OR 0.50 [0.30–0.79], p=0.004), indicating greater risk with acidemia.
Methodological Strengths
- Clearly defined transition window (first 72 hours after NMBA weaning attempt)
- Multicenter observational cohort with predefined endpoints and effect estimates (ORs)
Limitations
- Observational design limits causal inference
- Partial reporting of physiologic predictors and PSV failure metrics in abstract; potential residual confounding
Future Directions: Prospective interventional trials to test standardized transition-phase protocols (sedation, ventilator settings, NMBA reintroduction criteria) and external validation of predictors across diverse ARDS etiologies.
BACKGROUND: Protective ventilation during the acute phase of ARDS and weaning from mechanical ventilation are well-established in current guidelines. However, the intermediate transition phase between these stages remains poorly characterized. OBJECTIVES: To describe the transition phase in moderate-to-severe ARDS and evaluate the factors associated with neuromuscular blockade (NMBA) weaning failure and pressure support ventilation (PSV) failure. METHODS: This bicentric observational cohort study included patients with moderate-to-severe ARDS requiring NMBA continuous infusion within 72 h post-intubation. The transition phase was defined as the 72 h following the first NMBA weaning attempt. The main endpoints were the rates of NMBA reintroduction and PSV failure. Secondary outcomes included predictive factors for NMBA weaning failure and PSV failure and the impact of tidal volume on patient outcomes. MAIN RESULTS: A total of 196 patients were included. NMBA weaning failure occurred in 74 (38%) patients. COVID-19 (OR 3.98 [1.95-8.41], p < 0.001), pH (OR 0.50 [0.30-0.79], p = 0.004), PaO 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. The transition phase therefore represents a critical area for future research to optimize management during this vulnerable period.
2. The Association Between Neonatal Respiratory Distress Syndrome and Plasma IgG N-Glycosylation: A Case-Control Study.
Case-control glycomics of 88 NRDS and 120 controls showed distinct IgG N-glycosylation shifts (higher sialylation and core fucosylation; lower galactosylation) and identified PROM and GGT as independent risk factors. A composite model (GP1, GP13, GP14, PROM, GGT) achieved an AUC of 0.902.
Impact: This study introduces clinically relevant IgG glycosylation signatures and a high-performing diagnostic model for NRDS, advancing biomarker discovery in neonatal respiratory disease.
Clinical Implications: IgG N-glycosylation profiling could complement clinical risk factors (PROM, GGT) to improve early NRDS risk stratification and diagnosis, pending external validation and assay standardization.
Key Findings
- PROM was an independent risk factor for NRDS (OR 9.043 [1.036–78.966], p=0.046).
- Elevated GGT independently associated with NRDS (OR 1.015 [1.001–1.029], p=0.032).
- NRDS showed increased GP1, GP3, GP4, GP11, GP13, GP24 and decreased GP14; sialylation and core fucosylation increased while galactosylation decreased.
- Composite model (GP1, GP13, GP14, PROM, GGT) yielded AUC 0.902 (95% CI 0.851–0.953).
Methodological Strengths
- UPLC-based quantitative IgG N-glycan profiling
- Multivariable analysis with independent risk factors and ROC-based model performance
Limitations
- Case-control design limits causal inference
- Moderate sample size without external validation; potential selection bias
Future Directions: Prospective, multi-center validation of the glycan-based model; mechanistic studies linking IgG glycosylation changes to NRDS pathophysiology and response to surfactant therapy.
BACKGROUND: Neonatal respiratory distress syndrome (NRDS) is the leading cause of neonatal death. Changes in plasma immunoglobulin G (IgG) N-glycosylation have been demonstrated in a variety of diseases. However, its implications and clinical significance in NRDS remain to be clarified. METHODS: To determine the effect of IgG N-glycosylation on NRDS, we recruited 88 NRDS participants and 120 control participants from December 2021 to September 2022. Plasma was collected, IgG was isolated and purified, and the glycogram was analyzed by ultra performance liquid chromatography (UPLC) with fluorescence detector. RESULTS: The occurrence of premature rupture of membranes (PROM) [OR=9.043(1.036-78.966), P=0.046] and the elevation of γ-glutamyltransferase (GGT) [OR=1.015(1.001-1.029), P=0.032] were independent risk factors for the occurrence of NRDS. Furthermore, the area percentages of GP1, GP3, GP4, GP11, GP13, and GP24 were significantly higher in NRDS patients compared with control group. Conversely, GP14 was observed to be significantly lower. Furthermore, an increase in plasma IgG sialylation and core fucosylation was observed in NRDS, whereas the modification with galactosylation was decreased. The model constructed using GP1, GP13, GP14, PROM, and GGT as composite indices demonstrated robust predictive performance (AUC=0.902, 95% CI: 0.851-0.953). CONCLUSION: Patients with NRDS frequently exhibit alterations in the glycosylation of plasma IgG. These findings provide new insights into the diagnosis of NRDS and clinical treatment.
3. Nationwide analysis of COVID-19 complications, outcomes, and costs of childbirth in Spain.
Among 779,387 childbirth hospitalizations in Spain (2020–2022), 2.06% had COVID-19 at delivery. COVID-19-positive patients had longer hospital stays and higher rates of ICU admission (2.53%), ventilation/intubation (0.91%), and in-hospital mortality (0.06%), with increased direct hospital costs.
Impact: This nationwide registry quantifies the added critical care burden and costs of COVID-19 at delivery, informing resource allocation and preventive strategies for obstetric care.
Clinical Implications: Obstetric services should prioritize vaccination and screening and prepare ICU capacity and ventilation readiness for COVID-19-positive deliveries, given observed increases in ICU use, ventilation, mortality, and costs.
Key Findings
- COVID-19 at delivery occurred in 2.06% (15,792/779,387) of childbirth hospitalizations.
- COVID-19-positive patients had higher ICU admission (2.53%), ventilation/intubation (0.91%), and in-hospital mortality (0.06%).
- Hospital length of stay was longer and direct hospital costs were higher in COVID-19-positive deliveries.
Methodological Strengths
- Nationwide, population-based registry with very large sample size
- Direct comparison of clinical outcomes and hospital costs between COVID-19-positive and negative deliveries
Limitations
- Retrospective administrative database with potential coding and unmeasured confounding
- Findings reflect 2020–2022 variants; generalizability to current variants may differ
Future Directions: Linkage with vaccination records and variant-specific periods to refine risk estimates; prospective evaluation of preventive protocols in obstetric settings.
INTRODUCTION: Pregnant women are considered a vulnerable group for COVID-19 with an increased risk for complications. The objective of this study is to describe in-hospital mortality, pregnancy outcomes, and direct hospital costs associated with COVID-19 in women at the time of childbirth. METHODS: This retrospective nationwide population-based registry study collects data on complications, outcomes, and direct hospital costs from women hospitalized for childbirth, recorded in the Minimum Basic Data Set obtained from the National Surveillance System for Hospital Data in Spain between 2020-2022. Hospitalization characteristics, complications related to pregnancy and childbirth, outcomes, and hospitalization costs are compared between COVID-19-positive and non-COVID-19 women at the time of childbirth. RESULTS: A total of 779,387 women were admitted between 2020 and 2022 with a record of childbirth in Spanish hospitals. Of these, 15,792 (2.06%) had COVID-19 at the time of delivery. These women had a longer length of stay (3.53 days), higher rates of intensive care unit (ICU) admission (2.53%), ventilation/intubation (0.91%), and in-hospital mortality (0.06%) ( CONCLUSION: These findings show that COVID-19 at the time of childbirth occurs in 2 out of every 100 cases and increases the risk of complications related to pregnancy and childbirth, as well as mortality and hospitalization costs. These data are related to SARS-CoV-2 variants circulating from 2020-2022, and current variants could give different risks. Our evaluation should be useful for health authorities to allocate resources and professionals to implement preventive measures, such as vaccination and screening, due to the increased morbidity, mortality and costs in this group.