Daily Ards Research Analysis

BACKGROUND: The overall benefits and potential risks of corticosteroids, frequently administered to critically ill patients remain uncertain. This systematic review and meta-analysis evaluated the efficacy and safety of corticosteroid therapy in critically ill patients with severe community-acquired pneumonia, sepsis or septic shock, or acute respiratory distress syndrome. We hypothesized that corticosteroids reduce short-term mortality in critically ill patients. METHODS: We performed a search of Medline, Embase, and the Cochrane Central Register of Controlled Trials from database inception up to November 30, 2024. The search was limited to randomized controlled trials in human populations published in English. Dichotomous outcomes are reported as relative risk (RRs) and continuous outcomes as mean differences (MDs), both with 95% confidence intervals (CIs). The primary outcome was short-term mortality (28-day or nearest reported). Secondary outcomes included ICU/hospital length of stay, mechanical ventilation duration, ventilator-free days at 28 days, oxygenation index, reversed shock in sepsis or septic shock, and adverse events. We evaluated heterogeneity using I RESULTS: Forty-three randomized controlled trials (n = 10853) were included. Corticosteroids reduced short-term mortality in critically ill patients compared to placebo (RR, 0.85; 95% CI, 0.77-0.94). Corticosteroid treatment for critically ill patients reduced intensive care unit (MD, - 2.02 days; 95% CI, - 3.14 - -0.90) and hospital (MD, - 2.66 days; 95% CI, - 4.58 - -0.74) lengths of stay, and duration of mechanical ventilation (MD, - 4.24 days; 95% CI, - 6.38 - -2.10); it increased ventilator-free days at 28 days (MD, 2.83 days; 95% CI, 1.20-4.47), improved oxygenation index (PaO CONCLUSIONS: Subgroup analysis indicated that early initiation (≤ 72 h), low-dose (e.g., < 400 mg/day hydrocortisone equivalent), and prolonged (≥ 7 days) corticosteroid therapy was associated with reduced short-term mortality in critically ill patients with severe community-acquired pneumonia or acute respiratory distress syndrome. For septic shock, combination therapy (hydrocortisone plus fludrocortisone) may enhance efficacy. CLINICAL TRIAL REGISTRATION: PROSPERO: CRD42024517843.

OBJECTIVES: Although preclinical evidence indicates that injurious mechanical ventilation may lead to acute kidney injury (AKI), relevant clinical evidence is limited. We aimed to investigate the association of driving pressure (a marker of injurious mechanical ventilation) with subsequent development of AKI in patients with acute respiratory distress syndrome (ARDS). DESIGN: Secondary analysis of individual patient-level data from seven ARDS Network and Prevention and Early Treatment of Acute Lung Injury (PETAL) Network randomized controlled clinical trials. SETTING: Adult ICUs participating in the ARDS Network and PETAL Network trials. PATIENTS: After exclusion of patients with early AKI (i.e., those who met AKI criteria within the first 2 d following ARDS onset), we classified the study population into two groups: "late AKI" and "no AKI." The "late AKI" group included patients who developed AKI more than 2 days but no longer than 7 days following ARDS onset. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 5367 patients with ARDS initially enrolled in trials, 2960 patients were included in the main analysis. Late AKI developed in 1000 patients (33.8%). After controlling for confounders, baseline driving pressure was independently associated with development of late AKI (each 1 sd increase in driving pressure was associated with a 35% increase in the odds of late AKI [odds ratio, 1.35; 95% CI, 1.15-1.58]). This result persisted in the sensitivity analysis, which did not exclude patients with early AKI, and in the sensitivity analysis, which included patients who developed AKI later than 7 days following ARDS onset. There was a threshold of driving pressure equal to 15 cm H 2 O for its association with development of late AKI. CONCLUSIONS: Driving pressure was associated with subsequent development of AKI in patients with ARDS suggesting that injurious mechanical ventilation may lead to AKI.

INTRODUCTION: Acute respiratory distress syndrome (ARDS) has a high mortality rate. The prognostic nutritional index (PNI), as a comprehensive indicator of nutritional and immune status, has shown prognostic value in various diseases, however, its role in predicting prognosis in ARDS remains uncertain. MATERIALS AND METHODS: This study is a retrospective study based on data from the Medical Information Mart for Intensive Care IV database. This study enrolled 2829 patients with ARDS. Kaplan-Meier survival curve and Cox proportional hazard model were applied to analyze the association between PNI and 30-d mortality in patients with ARDS according to the tertiles of PNI. Through subgroup analysis and interaction testing, further exploration was undertaken to illuminate the influence conferred by PNI on prognosis across different populations. RESULTS: The 30-d mortality rate for ARDS patients was 26.5%. The Kaplan-Meier survival curve revealed that higher PNI indicated higher survival probability. After adjustment for all confounding factors, PNI was significantly inversely associated with 30-d mortality in patients with ARDS (hazard ratio = 0.981, 95% confidence interval: 0.969-0.993). Subgroup analysis indicated that the negative correlation between PNI and 30-d mortality was more pronounced in males, married individuals, and those without comorbidity. In addition, PNI interacted significantly with cerebrovascular diseases, suggesting that the presence of cerebrovascular diseases may weaken the predictive efficacy of PNI. CONCLUSIONS: PNI is an effective predictor of 30-d mortality for ARDS patients, with a higher PNI being linked with improved survival rates.