Daily Ards Research Analysis

Lung-protective ventilation significantly influences outcomes in patients with acute respiratory distress syndrome (ARDS), but identifying optimal settings remains a challenge due to pronounced inter- and intrapatient variability in lung anatomy and pathophysiology. This study demonstrates that physics-based computational lung models tailored to individual patients can predict otherwise unobservable local lung states, enabling a quantitative analysis of regional ventilation and the mechanical load experienced by lung parenchyma during ventilation. For seven mechanically ventilated patients with ARDS, patient-specific computational models were generated using chest computed tomography (CT) scan and ventilatory waveform data. By numerically resolving the lung's interaction with ventilator-imposed pressure and flow, we predict both the regional ventilation and the dynamic, spatially heterogeneous states of the lung. Model-predicted ventilation distributions were validated against clinical measurements from bedside electrical impedance tomography (EIT). The predicted anteroposterior ventilation profiles exhibited excellent agreement with EIT, achieving a Pearson correlation of 96%. Across the full transverse cross section and over the dynamic ventilation range, the models achieved an average correlation exceeding 81% and a root mean square error below 15%. This first systematic validation study indicates that computational lung models can reliably estimate patient-specific regional ventilation. These findings support the use of such models as a tool for individualized decision-making in mechanical ventilation, offering insights into both anatomical and functional lung characteristics that are not directly observable at the bedside. By leveraging detailed patient data and physical modeling, these models have the potential to inform more personalized and physiologically grounded ventilator settings, improving care in critically ill patients with ARDS.

BACKGROUND: There is limited data on the effectiveness of pressure-controlled ventilation (PCV) and volume-controlled ventilation (VCV) in adult patients with acute respiratory failure. This study aimed to compare the effectiveness of these 2 ventilations. METHODS: We performed a comprehensive search of 4 electronic databases, including PubMed, Central, Scopus, and CINAHL, from inception to July 14, 2023. This systematic review included randomized controlled trials that compared VCV and PCV ventilator modes in intubated adult patients with acute respiratory failure from any condition. Eligible studies were evaluated for study characteristics and outcomes. Details of study characteristics included authors, publication year, country, study aims, study design, study population, and characteristics of eligible patients: age, sex, disease severity, and comorbidities. The outcomes of interest were the incidence of barotrauma or pneumothorax and the in-hospital mortality rate. Meta-analysis with a fixed-effect model was used to pool the results of included studies. RESULTS: There were 27 articles that were eligible; 4 articles met the study criteria. These studies included acute respiratory distress syndrome patients (3 studies) and chronic obstructive pulmonary disease patients with open heart surgery. The total patients in the VCV and PCV groups were 581 and 548, respectively. There was no significant difference in the incidence of barotrauma between the VCV and PCV groups (risk ratio = 0.79, 95% confidence interval: 0.56-1.12). The VCV group had a slightly higher mortality rate than the PCV group (risk ratio = 1.15, 95% confidence interval: 1.00-1.33). CONCLUSIONS: PCV and VCV had no significant difference in both barotrauma incidence and mortality rate. PCV mode may have slightly lower mortality and may be a preferable ventilator mode in patients with acute respiratory distress syndrome. Further included studies may be required to confirm the results of this study.

BACKGROUND: Practice and delivery of critical care in Asia varies according to healthcare structure, income setting, and cultural factors. Identifying research priorities specific to ICU patients and healthcare workers in Asia is needed to guide advancement of critical care in the region. METHODS: This was an international cross-sectional survey study with adapted methods from nominal group techniques. All members of the Asian Critical Care Clinical Trials (ACCCT) Group were invited to submit research question suggestions. Submitted research questions were combined into summarized research questions, grouped into research themes, and individually ranked by number of mentions based on the original question submission (popularity). National and Regional Representatives rated the top 15% most popular summarized research questions by pre-defined importance and feasibility criteria. RESULTS: Between September 20, 2024 and December 10, 2024, 160 of 228 general members of the ACCCT Group (response rate 70.2%) participated in this survey study. The participants were from 112 hospitals across 24 countries and regions within Asia. Participants submitted 408 research questions, which were categorized into 15 themes and combined into 197 summarized research questions. The top three themes, as ranked by the number of mentions, were infection/sepsis, general ICU care, and structure/training/staffing/teamwork/safety. A threshold of 4 mentions was used to identify 26 summarized research questions that represented the top 15% most popular questions. Research questions related to sepsis and acute respiratory distress syndrome were ranked most important and feasible across the region. CONCLUSION: Twenty-six of the most popular research questions in critical care were identified by Asian ICU workers and researchers to drive research agenda in Asia for the next decade.