Daily Ards Research Analysis
Two studies advance understanding across distinct ARDS-related populations. A single-center retrospective series reports outcomes of VV ECMO for viral pneumonia–induced ARDS in pregnant/early postpartum women, highlighting bleeding as the major mortality driver despite high maternal survival. A prospective pilot cohort in extremely preterm infants demonstrates feasibility of estimating inspiratory effort and dynamic transpulmonary driving pressure using EAdi during noninvasive ventilation.
Summary
Two studies advance understanding across distinct ARDS-related populations. A single-center retrospective series reports outcomes of VV ECMO for viral pneumonia–induced ARDS in pregnant/early postpartum women, highlighting bleeding as the major mortality driver despite high maternal survival. A prospective pilot cohort in extremely preterm infants demonstrates feasibility of estimating inspiratory effort and dynamic transpulmonary driving pressure using EAdi during noninvasive ventilation.
Research Themes
- ECMO management and safety in pregnancy-associated ARDS
- Bleeding complications and anticoagulation strategies during VV ECMO
- Noninvasive monitoring of inspiratory effort and transpulmonary driving pressure in preterm infants
Selected Articles
1. Inspiratory Effort and Dynamic Transpulmonary Driving Pressure in Extremely Preterm Infants.
This prospective pilot cohort used diaphragm electrical activity (EAdi) to estimate inspiratory effort and dynamic transpulmonary driving pressure in extremely preterm infants receiving noninvasive ventilation. Across recovery-phase RDS, evolving BPD, and term controls (n=40 total), average EAdi and ΔP metrics were reported, supporting feasibility of noninvasive physiologic monitoring.
Impact: Introduces an EAdi-based framework to estimate dynamic transpulmonary driving pressure in extremely preterm infants on NIV, enabling individualized support and potential VILI mitigation.
Clinical Implications: Incorporating EAdi-derived inspiratory effort and dynamic transpulmonary driving pressure into bedside assessment could personalize NIV settings, balance support with spontaneous effort, and reduce baro/volutrauma risk.
Key Findings
- Prospective, observational pilot cohort captured EAdi to estimate inspiratory effort and dynamic transpulmonary driving pressure during NIV.
- Included 10 infants recovering from RDS, 25 with evolving BPD, and 5 term controls (total n=40).
- Reported average EAdi and estimated ΔP metrics across groups, supporting feasibility of noninvasive physiologic monitoring.
Methodological Strengths
- Prospective design with predefined clinical phenotypes (RDS recovery, evolving BPD, term controls).
- Use of neuroventilatory signal (EAdi) to estimate mechanics noninvasively during NIV.
Limitations
- Pilot sample size with limited power to detect between-group differences.
- Abstract does not report validation against a gold standard or longer-term clinical outcomes.
Future Directions: Validate EAdi-derived ΔP against gold-standard measures (e.g., esophageal manometry), define actionable thresholds, and test NIV titration protocols guided by these metrics in randomized trials.
BACKGROUND: In preterm infants receiving noninvasive ventilation, data about inspiratory effort (ΔP RESEARCH QUESTION: What are the characteristics of ΔP STUDY DESIGN AND METHODS: Prospective, observational pilot cohort study, in which EAdi was recorded in neonates receiving noninvasive ventilation during recovery from respiratory distress syndrome (RDS), in those with evolving bronchopulmonary dysplasia (BPD), and in term controls. EAdi was used to estimate ΔP RESULTS: Ten patients with RDS, 25 patients with evolving BPD, and 5 control term neonates were studied. Average EAdi, ΔP INTERPRETATION: ΔP
2. Extracorporeal Membrane Oxygenation for Pregnant and Early Postpartum Women With Acute Respiratory Distress Syndrome Caused by Viral Pneumonia.
In a single-center retrospective series of 18 pregnant/early postpartum women with severe viral pneumonia–induced ARDS supported with VV ECMO, maternal and fetal survival were 83% and 61%, respectively. Major bleeding occurred in 38% and accounted for all maternal deaths; survival was comparable to nonpregnant women, underscoring bleeding as the key modifiable risk.
Impact: Provides contemporary outcomes and safety signals for VV ECMO in pregnancy-associated ARDS, highlighting bleeding as a principal determinant of maternal/fetal mortality.
Clinical Implications: ECMO programs caring for pregnant/postpartum ARDS should prioritize bleeding prevention and anticoagulation optimization, with multidisciplinary perinatal coordination; early ECMO consideration and careful ventilation strategies may improve outcomes.
Key Findings
- Maternal and fetal survival were 83% and 61% among 18 VV ECMO-supported pregnant/early postpartum women with viral pneumonia–induced ARDS.
- Major bleeding occurred in 38% during ECMO and accounted for all maternal deaths.
- Pre-ECMO MV duration ranged 0–6 days; total MV duration ranged 5–86 days.
- Survival among pregnant/early postpartum women on VV ECMO did not differ from nonpregnant women.
Methodological Strengths
- Clearly defined population (pregnant/early postpartum women with severe ARDS from viral pneumonia) treated with a uniform intervention (VV ECMO).
- Systematic capture of key outcomes and complications over an 8-year period.
Limitations
- Single-center, retrospective design with small sample size (n=18) limits generalizability and introduces selection bias.
- No concurrent control group and limited detail on anticoagulation protocols.
Future Directions: Multicenter registries and prospective studies to optimize anticoagulation and bleeding prevention, define perinatal care pathways, and identify predictors of fetal outcomes in ECMO-supported ARDS.
Pneumonia is a common nonobstetric cause of acute respiratory distress syndrome (ARDS) and is the leading cause of intensive care unit admission in pregnant women. Acute respiratory distress syndrome is the most frequent indication for venovenous extracorporeal membrane oxygenation (VV ECMO) during pregnancy, with viral pneumonia as the primary etiology. The objective of this study was to review the maternal and fetal outcomes of pregnant and postpartum women with severe ARDS who were supported with VV ECMO. This retrospective observational study was conducted at a single ECMO center from December 2015 to March 2023. Eighteen pregnant and postpartum women who were supported with VV ECMO due to severe ARDS caused by viral pneumonia were included. The maternal and fetal survival rates were 83% and 61%. Major bleeding was a common complication for patients while on ECMO (38%). All maternal deaths were due to major bleeding. For pre-ECMO respiratory support, the mechanical ventilation (MV) duration ranged from 0 to 6 days, and the total MV duration ranged from 5 to 86 days. Survival rate among pregnant/early postpartum women who were placed on VV ECMO for respiratory support was not different from nonpregnant women. Bleeding remains a major complication that is associated with maternal and fetal mortality.