Daily Ards Research Analysis
Today's ARDS-focused search identified a retrospective ICU case series showing that HSV-1 pneumonia can complicate the postoperative course in immunocompetent cardiac surgery patients, often meeting ARDS criteria and carrying high mortality. Quantitative PCR from BAL/BAS guided diagnosis (viral load >10,000 copies/mL), underscoring the need for prospective studies on screening and antiviral therapy.
Summary
Today's ARDS-focused search identified a retrospective ICU case series showing that HSV-1 pneumonia can complicate the postoperative course in immunocompetent cardiac surgery patients, often meeting ARDS criteria and carrying high mortality. Quantitative PCR from BAL/BAS guided diagnosis (viral load >10,000 copies/mL), underscoring the need for prospective studies on screening and antiviral therapy.
Research Themes
- Postoperative viral pneumonia after cardiac surgery
- HSV-1 reactivation and ARDS in ICU
- Diagnostic utility of quantitative PCR from BAL/BAS
Selected Articles
1. Herpes Simplex Virus Pneumonia in Immunocompetent Patients Undergoing Cardiac Surgery: Case Series.
In a retrospective ICU case series of postoperative cardiac surgery patients without known immunodeficiency, 15/43 tested had HSV-1 detected in BAL/BAS with high viral loads (median 3.21×10^6 copies/mL). Most were mechanically ventilated; 73.3% met ARDS criteria and in-hospital mortality was 66.7%, higher after urgent than elective surgery.
Impact: This study highlights HSV-1 pneumonia as a substantial contributor to postoperative respiratory failure and ARDS with high mortality in immunocompetent cardiac surgery patients, emphasizing diagnostic PCR thresholds.
Clinical Implications: Consider HSV-1 testing via quantitative PCR in BAL/BAS for postoperative cardiac surgery patients with deteriorating respiratory status unresponsive to antibiotics. Early recognition may guide antiviral therapy and ICU management, though prospective trials are needed to define screening strategies and treatment impact.
Key Findings
- 15 of 43 tested postoperative cardiac surgery patients (34.9%) had HSV-1 detected in BAL/BAS with high viral loads (median 3.21×10^6 copies/mL).
- Diagnosis occurred a median of 12 days after surgery.
- 86.7% required mechanical ventilation and 73.3% met ARDS criteria.
- In-hospital mortality was 66.7%, higher after urgent surgery (85.7%) vs elective (50.0%).
- All patients received antiviral therapy; inflammatory markers were elevated (CRP median 108.6 mg/L; PCT median 1.1 ng/mL).
Methodological Strengths
- Predefined diagnostic threshold using quantitative HSV-1 PCR (>10,000 copies/mL) from BAL/BAS.
- Multidisciplinary adjudication of HSV-1 pneumonia diagnosis with systematic perioperative data collection.
Limitations
- Retrospective case series without a control group limits causal inference.
- Only a subset of surgical patients was tested (43/818), introducing potential selection bias; antiviral effectiveness cannot be assessed.
Future Directions: Prospective surveillance studies to define HSV-1 screening criteria post-cardiac surgery, and randomized trials to assess early antiviral therapy's impact on ARDS development and mortality.
2. Herpes Simplex Virus Pneumonia in Immunocompetent Patients Undergoing Cardiac Surgery: Case Series.
In a retrospective ICU case series of postoperative cardiac surgery patients without known immunodeficiency, 15/43 tested had HSV-1 detected in BAL/BAS with high viral loads (median 3.21×10^6 copies/mL). Most were mechanically ventilated; 73.3% met ARDS criteria and in-hospital mortality was 66.7%, higher after urgent than elective surgery.
Impact: This study highlights HSV-1 pneumonia as a substantial contributor to postoperative respiratory failure and ARDS with high mortality in immunocompetent cardiac surgery patients, emphasizing diagnostic PCR thresholds.
Clinical Implications: Consider HSV-1 testing via quantitative PCR in BAL/BAS for postoperative cardiac surgery patients with deteriorating respiratory status unresponsive to antibiotics. Early recognition may guide antiviral therapy and ICU management, though prospective trials are needed to define screening strategies and treatment impact.
Key Findings
- 15 of 43 tested postoperative cardiac surgery patients (34.9%) had HSV-1 detected in BAL/BAS with high viral loads (median 3.21×10^6 copies/mL).
- Diagnosis occurred a median of 12 days after surgery.
- 86.7% required mechanical ventilation and 73.3% met ARDS criteria.
- In-hospital mortality was 66.7%, higher after urgent surgery (85.7%) vs elective (50.0%).
- All patients received antiviral therapy; inflammatory markers were elevated (CRP median 108.6 mg/L; PCT median 1.1 ng/mL).
Methodological Strengths
- Predefined diagnostic threshold using quantitative HSV-1 PCR (>10,000 copies/mL) from BAL/BAS.
- Multidisciplinary adjudication of HSV-1 pneumonia diagnosis with systematic perioperative data collection.
Limitations
- Retrospective case series without a control group limits causal inference.
- Only a subset of surgical patients was tested (43/818), introducing potential selection bias; antiviral effectiveness cannot be assessed.
Future Directions: Prospective surveillance studies to define HSV-1 screening criteria post-cardiac surgery, and randomized trials to assess early antiviral therapy's impact on ARDS development and mortality.
3. Herpes Simplex Virus Pneumonia in Immunocompetent Patients Undergoing Cardiac Surgery: Case Series.
In a retrospective ICU case series of postoperative cardiac surgery patients without known immunodeficiency, 15/43 tested had HSV-1 detected in BAL/BAS with high viral loads (median 3.21×10^6 copies/mL). Most were mechanically ventilated; 73.3% met ARDS criteria and in-hospital mortality was 66.7%, higher after urgent than elective surgery.
Impact: This study highlights HSV-1 pneumonia as a substantial contributor to postoperative respiratory failure and ARDS with high mortality in immunocompetent cardiac surgery patients, emphasizing diagnostic PCR thresholds.
Clinical Implications: Consider HSV-1 testing via quantitative PCR in BAL/BAS for postoperative cardiac surgery patients with deteriorating respiratory status unresponsive to antibiotics. Early recognition may guide antiviral therapy and ICU management, though prospective trials are needed to define screening strategies and treatment impact.
Key Findings
- 15 of 43 tested postoperative cardiac surgery patients (34.9%) had HSV-1 detected in BAL/BAS with high viral loads (median 3.21×10^6 copies/mL).
- Diagnosis occurred a median of 12 days after surgery.
- 86.7% required mechanical ventilation and 73.3% met ARDS criteria.
- In-hospital mortality was 66.7%, higher after urgent surgery (85.7%) vs elective (50.0%).
- All patients received antiviral therapy; inflammatory markers were elevated (CRP median 108.6 mg/L; PCT median 1.1 ng/mL).
Methodological Strengths
- Predefined diagnostic threshold using quantitative HSV-1 PCR (>10,000 copies/mL) from BAL/BAS.
- Multidisciplinary adjudication of HSV-1 pneumonia diagnosis with systematic perioperative data collection.
Limitations
- Retrospective case series without a control group limits causal inference.
- Only a subset of surgical patients was tested (43/818), introducing potential selection bias; antiviral effectiveness cannot be assessed.
Future Directions: Prospective surveillance studies to define HSV-1 screening criteria post-cardiac surgery, and randomized trials to assess early antiviral therapy's impact on ARDS development and mortality.