Daily Ards Research Analysis

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has emerged as an advanced therapeutic option for managing acute respiratory distress syndrome (ARDS), especially severe cases of ARDS. However, the mortality remains high among these patients. Therefore, this meta-analysis aims to evaluate the mortality rates and its potential risk and protective factors in ARDS patients receiving ECMO support. METHODS: We systematically searched databases including PubMed, the Cochrane Library, Embase, and Web of Science for relevant studies from their respective inception to April 27, 2024. STATA 16 was used for data analysis. The quality of the included studies was assessed by the Newcastle-Ottawa Scale (NOS). RESULTS: A total of 70 studies involving 31,666 ARDS patients were included. The overall mortality was 48% in ARDS patients receiving ECMO support, especially high in coronavirus disease 2019 (COVID-19) related ARDS patients (60%), and the average hospital length of stay (LOS) of survivors [standardized mean difference (SMD) =0.84, 95% CI: 0.30-1.38] was significantly longer than non-survivors. Moreover, the results showed that age [odds ratio (OR) =1.02, 95% confidence interval (CI): 1.01-1.03], body mass index (BMI) [hazard ratio (HR) =0.96, 95% CI: 0.9-0.98], Sequential Organ Failure Assessment (SOFA) score (OR =1.05, 95% CI: 1.02-1.08), ECMO driving pressure (OR =1.07, 95% CI: 1.05-1.10), immunocompromised status (OR =1.07, 95% CI: 1.05-1.09), and total respiratory rate from days 1 to 3 on ECMO (OR =1.04, 95% CI: 1.01-1.08) were all significant predictors for mortality. CONCLUSIONS: The current meta-analysis provides valuable insights into the intricate factors influencing mortality rate in ARDS patients on ECMO. The influencing factors for mortality should be further explored in the future, which may help reduce the global burden of ARDS.

BACKGROUND: The management of mechanical ventilation (MV) for patients with intracerebral hemorrhage (ICH) remains controversial. Lung protective ventilation (LPV) has been shown to reduce mortality in critically ill patients, such as those with acute respiratory distress syndrome (ARDS). METHODS: ICH model was created in male C57BL/6 mice by injecting autologous blood into the basal ganglia, followed by LPV [tidal volume (VT) =6 mL/kg, positive end-expiratory pressure (PEEP) =5 cmH2O]. Neurobehavioral assessments were conducted at 3, 7, and 14 days, and neuronal injury was evaluated using Nissl staining. Inflammatory factors in brain tissue, serum, and bronchoalveolar lavage fluid (BALF) were analyzed by enzyme-linked immunosorbent assay (ELISA). Lung tissue was examined using hematoxylin-eosin (H&E) staining. Immunofluorescence detected Nrf2 translocation into the nucleus, and Western blot assessed Nrf2/HO-1 pathway proteins and inflammatory markers. The Nrf2 inhibitor ML385 was administered before modeling to assess the reversal of LPV's effects. RESULTS: Conventional tidal-volume ventilation (CTV) significantly exacerbated cerebral edema compared with the ICH-only group, whereas LPV markedly reduced brain water content (wet-dry ratio). In behavioral tests, LPV‑treated mice displayed the shortest sticker removal times, highest Garcia scores, lowest Foot‑fault rates, and longest Rotarod endurance among all groups. Nissl staining revealed increased neuronal injury and apoptosis after ICH, worst in the CTV group; LPV preserved more viable neurons, indicating significant neuroprotection. Pulmonary histopathology on day 5 showed the most severe lung damage in CTV mice, intermediate damage in ICH-only mice, and significantly milder injury in LPV-treated mice. The lung wet-dry ratio was highest in CTV animals, while LPV significantly alleviated pulmonary edema. BALF cytokine analysis revealed the highest interleukin-1 beta (IL‑1β), interleukin-6 (IL‑6), and tumor necrosis factor-alpha (TNF‑α) levels in the CTV group, moderate levels in ICH, and lowest levels in LPV, indicating reduced lung inflammation. In both serum and brain tissue, LPV significantly lowered levels of IL‑1β, inducible nitric oxide synthase (iNOS), IL‑6, and TNF‑α compared with ICH and CTV groups; oxidative stress markers also improved. WB and immunofluorescence show that LPV promoted nuclear translocation of Nrf2 and upregulated downstream HO‑1. Superoxide dismutase (SOD) activity increased and malondialdehyde (MDA) levels decreased in the LPV group, consistent with activation of the Nrf2/HO‑1 antioxidant pathway. Inhibition of Nrf2 using ML385 reduced Nrf2 nuclear localization and HO‑1 expression, partially reversed LPV's anti‑inflammatory and antioxidant effects, increased iNOS, worsened brain inflammation, and diminished neurological improvement. CONCLUSIONS: Significant lung injury was evident on the 5th day after ICH. LPV alleviated neuronal damage, improved neurobehavioral outcomes, and reduced IL-6, IL-1β, and TNF-α in lung, blood, and brain. LPV activated the Nrf2/HO-1 pathway, decreasing oxidative stress. ML385 reversed LPV's protective effects on the brain and lung.

BACKGROUND: Tracheostomy is often performed to facilitate weaning in invasively ventilated patients. There are studies regarding tracheostomy in acute respiratory distress syndrome (ARDS) patients, but its practice in ARDS patients due to coronavirus disease 2019 (COVID-19) remains uncertain. The aim of the study was to compare incidences of tracheostomy among three nations and to analyze outcomes associated with tracheostomy in COVID-19 ARDS patients. METHODS: Post hoc analysis of patient-level data on tracheostomy in patients with COVID-19 ARDS from nationwide ventilation studies in Argentina, Spain, and the Netherlands. The primary endpoint was incidence and timing of tracheostomy. A propensity matched analysis was used to correct for factors with a known association with mortality, and a sensitivity analysis was performed to correct for the risk of death and the chance of receiving a tracheostomy. All three studies included patients that were admitted to a participating intensive care unit (ICU); aged >18 years; receiving ventilatory support; confirmed to have COVID-19 pneumonia. Patients were excluded from participation when there was an alternate cause for pneumonia. For the current analysis, we additionally excluded patients not having ARDS. RESULTS: The analysis included 5,781 invasively ventilated patients: 1,469 (25%) patients from Argentina, 3,349 (58%) patients from Spain, and 963 (17%) patients from the Netherlands. Tracheostomies were performed 24% in Argentina {median 20 [16-24] days}, 40% in Spain {median 16 [12-21] days}, and 18% in the Netherlands {median 21 [17-27] days}. In unmatched and matched analyses 60-day mortality was lower in patients that received a tracheostomy. CONCLUSIONS: Both the incidence and timing of tracheostomy in COVID-19 ARDS patients differed among the three nations. Tracheostomy was associated with lower mortality rates.