Daily Ards Research Analysis
Today's top ARDS-adjacent research spans translational device science, survivorship outcomes, and practice patterns. A novel atomization approach for surfactant delivery showed preserved biophysical function and improved distribution in an ex vivo preterm model, while VV-ECMO survivors reported substantial long-term disability and mental health burdens. A national multicenter survey highlighted heterogeneity and partial pathophysiology alignment in ventilation strategies from acute RDS to severe
Summary
Today's top ARDS-adjacent research spans translational device science, survivorship outcomes, and practice patterns. A novel atomization approach for surfactant delivery showed preserved biophysical function and improved distribution in an ex vivo preterm model, while VV-ECMO survivors reported substantial long-term disability and mental health burdens. A national multicenter survey highlighted heterogeneity and partial pathophysiology alignment in ventilation strategies from acute RDS to severe BPD.
Research Themes
- Innovations in surfactant delivery for preterm respiratory distress
- Long-term functional and mental health outcomes after VV-ECMO
- Practice variability in neonatal ventilation strategies toward severe BPD
Selected Articles
1. Characterization of atomization and delivery efficiency of exogenous surfactant in preterm infant lungs using an ex vivo respiratory model.
Using an ex vivo preterm respiratory model, the Endosurf device atomized Curosurf without altering surface tension, reduced vesicle size, and produced more homogeneous lung distribution. Rheology indicated viscoelastic complexity post-atomization, supporting feasibility for noninvasive surfactant delivery in preterm RDS.
Impact: Introduces a potentially practice-changing delivery modality for surfactant that could reduce invasiveness and improve distribution in preterm lungs. Provides mechanistic and proof-of-concept data that justify future clinical trials.
Clinical Implications: If validated in vivo, atomized surfactant delivery could reduce intubation/bolus instillation needs, harmonize dosing, and enhance alveolar recruitment in preterm infants with RDS.
Key Findings
- Endosurf atomization preserved Curosurf surface tension while reducing vesicle size.
- Ex vivo rabbit lung model showed more homogeneous regional deposition/distribution.
- Rheological testing revealed viscoelastic complexity after atomization, informing delivery parameters.
Methodological Strengths
- Integrated biophysical characterization (surface tension, rheology, vesicle sizing).
- Physiologically relevant ex vivo preterm thorax model enabling regional deposition mapping.
Limitations
- Ex vivo rabbit model may not replicate human neonatal airway geometry and dynamics.
- No in vivo efficacy or safety outcomes; clinical dosing and airway responses remain untested.
Future Directions: Proceed to animal in vivo studies to optimize aerosol parameters and then phase I/II neonatal trials comparing atomized versus standard bolus surfactant delivery on oxygenation, ventilation, and complications.
Administration of pulmonary surfactant is crucial for the treatment of respiratory distress syndrome (RDS) in preterm infants. The aim of this study is to evaluate the potential of Curosurf atomization via the Endosurf device, a recently developed spray technology, as a promising approach for surfactant delivery in infants with RDS. A comprehensive analysis was performed to evaluate the physicochemical properties of atomized Curosurf, including its surface tension and rheology. The size distribution of Curosurf vesicles was also investigated. An ex vivo respiratory model based on rabbit lungs breathing through an instrumented hypobaric chamber representing the thorax of a preterm infant was developed to provide proof of concept for regional aerosol deposition of atomized Curosurf. The atomization of Curosurf with the innovative Endosurf device did not significantly alter surface tension, but reduced vesicle size and promoted homogeneous distribution of Curosurf in the lungs. Rheological measurements showed the viscoelastic complexity of atomized Curosurf. This preliminary study confirmed the promising potential of Curosurf atomization via the Endosurf device for the distribution of surfactant in the lungs of infants with RDS. These advances could help to improve the treatment of RDS in preterm infants and offer new perspectives for healthcare professionals and affected families.
2. Functional outcomes among the survivors of veno-venous extracorporeal membrane oxygenation during the COVID-19 pandemic: a historical cohort study.
In a historical cohort of 26 VV-ECMO survivors (85% COVID-19), disability burden was substantial at a median 22 months, with WHODAS 2.0 median 26, mobility/participation most affected, and only 50% returning to the same work capacity. Depression (40%) and PTSD (28%) were frequent, underscoring need for long-term rehabilitation and mental health care.
Impact: Provides systematically measured, multidomain long-term outcomes in VV-ECMO survivors, quantifying persistent disability and psychological morbidity beyond hospital discharge.
Clinical Implications: ECMO programs should embed longitudinal follow-up with rehabilitation, pain management, cognitive screening, and mental health services, and counsel patients on realistic recovery trajectories.
Key Findings
- Median WHODAS 2.0 score 26 with highest disability in mobility and participation domains at ~22 months post-ECMO.
- Only 50% of previously full-time employed patients returned to the same work capacity.
- High symptom burden: moderate pain 52%, anxiety 38%, depression 40%, and PTSD 28%.
Methodological Strengths
- Use of validated instruments across multiple domains (WHODAS 2.0, mRS, EQ-5D-5L, T-MoCA, PHQ-9, IES-6).
- Long median follow-up of 22 months post-ECMO separation.
Limitations
- Small sample size (N=26) limits precision and generalizability.
- Historical retrospective design with descriptive analysis; no comparator group.
Future Directions: Prospective multicenter cohorts with matched controls to identify predictors of poor recovery and to test structured post-ECMO rehabilitation/psychological interventions.
PURPOSE: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is increasingly being used in patients with respiratory failure. The goal of this study was to characterize postdischarge psychological and functional outcomes of this patient population. METHODS: We conducted a historical cohort study of survivors who required VV-ECMO during the COVID-19 pandemic. Using telephone interviews, we assessed the following domains: disability (using the World Health Organization Disability Schedule [WHODAS 2.0] and modified Rankin Scale [mRS]), health-related quality of life (using the European Quality of Life 5 Dimensions 5 Level tool), cognition (using the telephone Montreal Cognitive Assessment tool), depression (using the Patient Health Questionnaire-9), and posttraumatic stress disorder symptoms (using the Impact of Event Scale-6). We used descriptive statistics to analyze our results. RESULTS: Twenty-six participants with a median [interquartile range (IQR)] age of 47 [42-59] yr and 6 (23%) of whom were female were evaluated at a median [IQR] of 22 [17-23] months after ECMO separation. Twenty-two (85%) had a diagnosis of COVID-19. The median [IQR] WHODAS 2.0 score was 26 [15-30] with the highest degree of disability in the mobility and participation domains. Of the 24 participants who were employed full-time, 12 (50%) were able to work in the same capacity. Of the 25 respondents who were living independently at baseline, 22 (88%) maintained complete independence for their activities of daily living (mRS < 3), one (4%) described persistent functional limitations (mRS = 3), and two (8%) required constant care (mRS = 4 or 5). Thirteen (52%) and nine (38%) reported at least moderate pain or anxiety, respectively. Ten (40%) and seven (28%) participants screened positive for symptoms of depression or posttraumatic stress disorder, respectively. CONCLUSIONS: Patients who required VV-ECMO experienced significant functional disability, pain, cognitive challenges, mental health problems, and lower quality of life approximately two years after discharge. RéSUMé: OBJECTIF: L’oxygénation par membrane extracorporelle veino-veineuse (ECMO-VV) est de plus en plus utilisée chez la patientèle souffrant d’insuffisance respiratoire. L’objectif de cette étude était de caractériser les devenirs psychologiques et fonctionnels après le congé de cette patientèle. MéTHODE: Nous avons mené une étude de cohorte historique sur des survivantes et survivants qui ont nécessité une ECMO-VV pendant la pandémie de COVID-19. Dans le cadre d’entrevues téléphoniques, nous avons évalué les domaines suivants : l’incapacité (à l’aide de l’Instrument d’évaluation de l’invalidité de l’Organisation mondiale de la Santé [WHODAS 2.0] et de l’échelle de Rankin modifiée [mRS]), la qualité de vie liée à la santé (à l’aide de l’Outil européen de qualité de vie 5 dimensions à 5 niveaux), la cognition (à l’aide de l’outil d’évaluation cognitive de Montréal par téléphone), la dépression (à l’aide du questionnaire sur la santé du patient PHQ-9) et les symptômes de trouble de stress post-traumatique (à l’aide de l’échelle d’impact des événements-6). Nous avons utilisé des statistiques descriptives pour analyser nos résultats. RéSULTATS: Nous avons évalué vingt-six personnes, avec un âge médian [écart interquartile (EIQ)] de 47 [42-59] ans et dont 6 (23 %) étaient des femmes, à une médiane [EIQ] de 22 [17-23] mois après le sevrage de l’ECMO. Vingt-deux (85 %) avaient reçu un diagnostic de COVID-19. Le score médian [EIQ] WHODAS 2.0 était de 26 [15-30] avec le degré d’incapacité le plus élevé dans les domaines de la mobilité et de la participation. Des 24 personnes participantes qui occupaient un emploi à temps plein, 12 (50 %) étaient en mesure de travailler dans la même capacité. Sur les 25 personnes répondantes qui vivaient de manière autonome au départ, 22 (88 %) ont conservé une indépendance complète pour leurs activités de la vie quotidienne (mRS < 3), une (4 %) a décrit des limitations fonctionnelles persistantes (mRS = 3) et deux (8 %) ont nécessité des soins constants (mRS = 4 ou 5). Treize (52 %) et neuf (38 %) ont signalé une douleur ou une anxiété au moins modérée, respectivement. Dix (40 %) et sept (28 %) participants et participantes ont obtenu des résultats positifs pour des symptômes de dépression ou de trouble de stress post-traumatique, respectivement. CONCLUSION: Les patientes et patients qui avaient eu besoin d’une ECMO-VV ont présenté une incapacité fonctionnelle importante, de la douleur, des problèmes cognitifs, des problèmes de santé mentale et une qualité de vie inférieure environ deux ans après leur congé.
3. Adaptation of ventilation strategies from acute RDS to severe BPD: A national multicenter survey of practices in extremely preterm infants.
In a 39-center national survey of extremely preterm care, PC-AC with volume guarantee predominated in acute RDS/evolving BPD, whereas HFOV was most used in severe BPD; SIMV with VG and PS increased as disease progressed. Ventilator settings partially followed pathophysiology-based recommendations, but early strategies often persisted into severe phases.
Impact: Identifies actionable gaps between pathophysiological recommendations and real-world ventilation practices across disease phases, informing standardization and trials.
Clinical Implications: Guideline updates and quality improvement can target alignment of ventilator modes/settings with disease phase in BPD trajectories, and prompt transition strategies as mechanics evolve.
Key Findings
- Across 39 centers, PC-AC with volume guarantee was most preferred in RDS/evolving BPD; HFOV predominated in severe BPD.
- Use of SIMV with volume guarantee and pressure support increased with disease progression.
- Settings were modified according to pathophysiological rationale, but not to the recommended extent; early strategies often persisted.
Methodological Strengths
- National multicenter sampling across high-level NICUs caring for extremely preterm infants.
- Phase-specific queries capturing transitions from acute RDS to severe BPD.
Limitations
- Survey design with self-reported practices is subject to recall and social desirability biases.
- Findings from a single national context may not generalize globally; no outcome data.
Future Directions: Develop consensus pathways and test protocolized ventilation transitions in pragmatic trials measuring respiratory mechanics, oxygenation, and BPD/sequelae outcomes.
Advances in diagnostic and therapeutic methods have led to a paradigm shift in the management of bronchopulmonary dysplasia (BPD). The lack of evidence-based data in this area has led to variations in clinical practice. The aim of this study was to identify these differences and compare them with recommendations based on pathophysiology. The study was designed as an observational online survey of neonatologists from level 3 to 4 neonatal intensive care units caring for premature infants at increased risk of BPD and born before 28 weeks' gestation. Respondents were invited to participate in the study through the portal of the Turkish Neonatal Society. Participants were surveyed online about preferred ventilation modes, settings and clinical management of these patients through each respiratory distress syndrome, evolving BPD and severe BPD phases. A total of 39 centers involved in the study. Pressure-control assist-control volume-guaranteed was the most commonly preferred ventilation mode in respiratory distress syndrome and evolving BPD, while high frequency oscillatory ventilation was most commonly used in severe BPD. The use of synchronized intermittent mandatory ventilation volume-guaranteed pressure support ventilation increased with disease progression. Ventilation settings were found to be changed according to pathophysiological recommendations, but not to the extent recommended. The study shows that early ventilation strategies are predominantly maintained in the later phases of BPD, although there are notable differences between centers.