Daily Ards Research Analysis
Two ICU-focused studies address ARDS-related questions: a multicenter cohort of Legionella pneumonia found similar 28-day mortality with ECMO versus non-ECMO despite higher severity, and a physiologic study tests whether bioimpedance-derived thoracic fluid content tracks extravascular lung water and preload changes in ARDS during a fluid challenge. A large perinatal tumor cohort quantifies prenatal detection gaps and metastasis differences, informing multidisciplinary planning.
Summary
Two ICU-focused studies address ARDS-related questions: a multicenter cohort of Legionella pneumonia found similar 28-day mortality with ECMO versus non-ECMO despite higher severity, and a physiologic study tests whether bioimpedance-derived thoracic fluid content tracks extravascular lung water and preload changes in ARDS during a fluid challenge. A large perinatal tumor cohort quantifies prenatal detection gaps and metastasis differences, informing multidisciplinary planning.
Research Themes
- ECMO decision-making in ARDS
- Validation of noninvasive hemodynamic monitoring
- Prenatal oncology detection and outcomes
Selected Articles
1. Does the thoracic fluid content reflect lung water and cardiac preload?
In 42 ICU patients equipped with TPTD (PiCCO2), the authors prospectively measured GEDVI, EVLWI, and CVP before and after a standardized 500-mL fluid bolus to test whether bioimpedance-derived thoracic fluid content (TFC) tracks changes in thoracic water and cardiac preload. The study specifically assessed correlations between TFC and EVLWI in ARDS.
Impact: It addresses a clinically important validation question for a widely used noninvasive monitoring metric (TFC) against gold-standard TPTD-derived measures during a controlled fluid challenge.
Clinical Implications: If TFC reliably tracks EVLWI and preload changes, clinicians could use bioimpedance to guide fluid management and monitor lung water noninvasively in ARDS and shock settings.
Key Findings
- In 42 ICU patients with PiCCO2 monitoring, GEDVI, EVLWI, and CVP were measured before and after a standardized 500-mL fluid bolus.
- The study directly compared bioimpedance-derived TFC changes with established preload markers (GEDVI, CVP).
- Correlations between TFC and TPTD-derived EVLWI were assessed specifically in patients with ARDS.
Methodological Strengths
- Prospective pre–post fluid challenge with standardized 500-mL bolus
- Use of gold-standard transpulmonary thermodilution (TPTD) metrics (GEDVI, EVLWI) for comparison
Limitations
- Single-arm physiologic study without randomization or blinding
- Modest sample size (n=42) and potential bioimpedance measurement confounders (e.g., chest wall factors)
Future Directions: External validation with larger, multicenter cohorts; assessment across different ventilatory settings; determine actionable TFC thresholds linked to outcomes.
UNLABELLED: Whether the thoracic fluid content (TFC) estimated by bioimpedance actually reflects the thoracic water content and tracks its changes has not been tested yet. We compared TFC changes induced by volume expansion with those of well-established markers of cardiac preload including the global end-diastolic volume indexed (GEDVI) estimated by transpulmonary thermodilution (TPTD) and central venous pressure (CVP). We assessed the relationship between TFC and extravascular lung water indexed (EVLWI) estimated by TPTD in patients with acute respiratory distress syndrome (ARDS). In 42 patients with a TPTD device (PiCCO2), we measured GEDVI, EVLWI and CVP before and after a 500-mL fluid bolus ( SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10877-025-01335-6.
2. Demographics and outcome of Legionella pneumonia in the intensive care unit: a retrospective multicenter cohort study.
Among 110 ICU patients with Legionella pneumonia across three centers, 40% received ECMO. Despite higher SOFA scores, 28-day mortality was similar between ECMO and non-ECMO groups (25% vs 21%; OR 1.24; p=0.64). Hospital-acquired LP and higher lactate independently predicted 28-day mortality; only 57% had adequate initial antibiotic coverage.
Impact: This multicenter cohort provides condition-specific ECMO outcome data for Legionella-associated ARDS and identifies readily assessable mortality predictors, informing bedside decisions.
Clinical Implications: Comparable mortality despite higher severity supports considering ECMO for refractory LP-related ARDS; prompt adequate anti-Legionella coverage and attention to hospital-acquired status and lactate are critical.
Key Findings
- ECMO was used in 40% of 110 ICU Legionella pneumonia patients; 28-day mortality was similar between ECMO and non-ECMO (25% vs 21%; OR 1.24; p=0.64).
- ECMO patients had higher severity (SOFA 12 vs 9 at 24 h; p<0.001) yet no excess mortality compared with non-ECMO.
- Only 57% had adequate anti-Legionella antibiotic coverage at ICU admission; outcomes did not differ by initial adequacy.
- Hospital-acquired LP (OR 28.4; p=0.006) and lactate (OR 1.31; p=0.031) independently predicted 28-day mortality.
Methodological Strengths
- Multicenter cohort across three tertiary hospitals over a 10-year period
- Adjusted analyses identifying independent predictors of 28-day mortality
Limitations
- Retrospective design with potential selection and treatment allocation biases
- Limited power for subgroup analyses and unmeasured confounding (e.g., ECMO timing, ventilator settings)
Future Directions: Prospective registries or pragmatic trials assessing ECMO timing and standardized care bundles in LP-related ARDS; stewardship to improve early appropriate antibiotic coverage.
BACKGROUND: Legionella pneumonia (LP) is a major cause of severe community-acquired pneumonia (CAP) that can lead to acute respiratory distress syndrome (ARDS) with high morbidity and mortality. ARDS may necessitate extracorporeal membrane oxygenation (ECMO) support, and evidence is limited about benefits of ECMO in LP. Therefore, we sought to analyze the clinical course, outcomes and predictive factors of ECMO patients with ARDS due to LP compared to non ECMO patients. METHODS: This retrospective, multicenter cohort study analyzed ICU patients with LP across three tertiary university hospitals (Zurich, Switzerland; Hannover & Bonn, Germany) from 2013 to 2023. We examined demographics, clinical characteristics, and outcomes, with a focus on ECMO utilization and its impact on mortality. RESULTS: A total of 110 patients were included, with a median age of 60 years and 75% male. ECMO support was initiated in 40%. The overall 28-day mortality did not differ between groups, with 21% without ECMO vs. 25% with ECMO (OR 1.24 (0.49-3.05, p = 0.64), despite higher degree of organ failure in the ECMO group (SOFA score 24 h after ICU admission 9 vs. 12, p < 0.001). Only 57% of patients had adequate antibiotic LP coverage at ICU admission with no differences in outcome. Multivariable analysis found hospital acquired LP (OR 28.4 (3.44-614), p = 0.006) and lactate (OR 1.31 (1.05-1.75), p = 0.031) as independent risk factor for 28-day mortality. CONCLUSIONS: Patients suffering from LP requiring ECMO support had similar mortality rates compared to LP patients without ECMO support, despite higher SOFA scores. In addition, LP-induced respiratory failure requiring ECMO had a lower mortality rate compared to the published literature on the overall ARDS population. This indirect indication of a potential survival benefit may support bedside clinicians in their decision-making regarding ECMO initiation or withholding.
3. Prenatal diagnosis and postnatal management of perinatal thoracoabdominopelvic tumors: multicenter experience.
In a retrospective multicenter cohort from Île-de-France (2010–2021), 153 perinatal thoracoabdominopelvic tumors were identified; 35% were detected prenatally (mostly in the third trimester). Distant metastasis occurred in 4% of prenatally detected cases versus 36% of postnatally detected cases, and 89% were alive at median 5-year follow-up.
Impact: Provides large-scale, granular epidemiology of perinatal solid tumors with concrete detection timelines and metastasis rates, informing screening and counseling.
Clinical Implications: Earlier prenatal detection may reduce metastatic presentation and enables planned multidisciplinary postnatal management; clinicians should maintain vigilance for retroperitoneal and adrenal masses.
Key Findings
- Among 153 tumors, main locations were adrenal (43%), retroperitoneum (12%), and kidney (12); neuroblastoma accounted for 61% of diagnoses.
- Prenatal detection occurred in 35% (mostly third trimester); diagnosis confirmed a median of 9 days after birth.
- Postnatal detection occurred in 65% at median 73 days; distant metastasis was 4% in prenatal vs 36% in postnatal detections.
- At median 5-year follow-up, 89% of patients were alive; 3% required early intensive care for complications.
Methodological Strengths
- Multicenter regional cohort with comprehensive capture of prenatal and postnatal detections
- Detailed phenotyping including timing, metastasis status, and outcomes
Limitations
- Retrospective design with potential referral and ascertainment biases
- Regional cohort may limit generalizability; heterogeneity across tumor types
Future Directions: Prospective registries integrating standardized prenatal imaging protocols and postnatal management pathways; evaluation of risk-based surveillance to improve prenatal detection.
OBJECTIVES: The primary objective was to assess the accuracy of prenatal examination in detecting and characterizing perinatal solid tumors of the thoracoabdominopelvic region. Secondary objectives were to describe the epidemiology, clinical characteristics and outcome of these tumors. METHODS: This was a retrospective multicenter study of all patients with a thoracic, abdominal or pelvic tumor diagnosed prenatally or within the first 3 months after birth in the Île-de-France area between January 2010 and May 2021. The gestational age at which a mass was detected on prenatal imaging, or the postnatal age at which the first tumor-related sign or symptom was noted, in addition to the timing of postnatal diagnostic confirmation (clinicoradiological or pathological), were extracted from patient medical files. RESULTS: Overall, 153 tumors were identified. An associated congenital malformation was identified in 14 (9%) infants and four (3%) had a known germline pathogenic variant. The main tumor locations were adrenal gland (43%), extra-adrenal and extrarenal retroperitoneum (12%) and kidney (12%). The most common diagnoses were neuroblastoma (93/153 (61%)) (including 65 adrenal, 20 extra-adrenal retroperitoneal and eight thoracic/mediastinal), hepatoblastoma (10/153 (7%)), teratoma (10/153 (7%)), nephroblastoma (8/153 (5%)) and congenital mesoblastic nephroma (7/153 (5%)). In 35% (53/153) of cases, a mass was detected prenatally (mainly during the third trimester (62%)) and the diagnosis was confirmed at a median of 9 (interquartile range (IQR), 2-20) days after birth. Tumor detection was postnatal in 65% (100/153) of cases, mainly on the basis of tumor mass syndrome (39%) or tumor palpation by parents or during a routine medical visit (36%), and occurred at a median of 73 (IQR, 39-104) days after birth. Distant metastasis was noted in 4% (2/53) of cases with a prenatal mass and in 36% (36/100) of cases detected postnatally. Five medical terminations of pregnancy for a compressive tumor were reported, in addition to one in-utero fetal demise. Five (3%) neonates required early supportive intensive care due to respiratory distress, arterial hypertension, intestinal perforation or intestinal obstruction. At a median follow-up of 5 (range, 0-14) years, 136 (89%) patients remained alive. CONCLUSIONS: Only 35% of perinatal thoracic, abdominal and pelvic tumors were detected before birth. Although mainly malignant, their prognosis was largely favorable. Improving early detection may assist postnatal multidisciplinary management and parental guidance. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.