Daily Ards Research Analysis

BACKGROUND: Mechanical power (MP) quantifies the total energy delivered from the ventilator to the respiratory system per unit time, integrating tidal volume, airway pressures, respiratory rate, and flow. MP has been proposed as a surrogate marker of ventilator-induced lung injury (VILI), but the consistency and generalizability of this association across patient populations remain uncertain. OBJECTIVES: To provide the most comprehensive systematic evaluation to date of the relationship between MP and VILI-related outcomes in adult patients receiving invasive mechanical ventilation. METHODS: We conducted a systematic review following PRISMA guidelines. Four databases (PubMed, Embase, Scopus, Web of Science) were searched for original studies reporting MP and clinical outcomes related to VILI. Risk of bias was assessed using RoB 2.0 and ROBINS-I tools. Certainty of evidence was rated using the GRADE approach. RESULTS: Forty-six studies including 314,823 patients were analyzed. Forty (87 %) demonstrated a statistically significant association between higher MP and adverse outcomes (mortality, prolonged ventilation, or ICU stay). Threshold effects were identified in 23 studies, most consistently between 14 and 18 J/min. Normalized MP (e.g., per predicted body weight or well-aerated lung volume) improved prognostic performance in selected cohorts. Despite heterogeneity and mostly observational designs, the overall signal was robust across diverse populations and clinical contexts. CONCLUSIONS: This review establishes mechanical power as a consistent and clinically relevant predictor of adverse outcomes in mechanically ventilated adults. By synthesizing >300,000 patients, it provides the most reliable evidence base to date, identifies reproducible thresholds, and highlights the importance of normalization strategies. These findings suggest that MP could complement tidal volume and driving pressure in lung-protective ventilation and define priorities for future prospective trials.

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by refractory hypoxemia resulting from ventilation-perfusion (V/Q) mismatch. Studies have shown that inhaled nitric oxide (iNO) and prone position (PP) ventilation may improve V/Q mismatch and oxygenation when used separately. Despite the known individual benefits of iNO and PP, few studies have investigated their potential synergistic effects. The aim of this study was to evaluate iNO combined with PP on V/Q matching and oxygenation in patients with moderate-to-severe ARDS. METHODS: A 2 × 2 factorial design was adopted in this study. Patients admitted to the Intensive Care Unit of Northern Jiangsu People's Hospital from January 2024 to December 2024, who met the diagnostic criteria for moderate-to-severe ARDS (aged 18-80 years, oxygenation index <150 mmHg, and requiring mechanical ventilation), were enrolled. The patients were administered with a combination of iNO therapy at 20 ppm while in the supine position (SP) and prone position (PP). Various clinical variables were collected at baseline in the SP, as well as at 4 and 12-h during PP, and after 30-60 min of iNO treatment (SP, SP + iNO, PP, PP + iNO). The pulmonary ventilation-perfusion status, such as the global inhomogeneity (GI) index of ventilation and perfusion, dead space fraction, intrapulmonary shunt fraction, and V/Q matching was monitored using electrical impedance tomography (EIT). Additionally, respiratory mechanics, gas exchange, and hemodynamic parameters were recorded. RESULTS: A total of 24 patients with severe ARDS were enrolled, including 17 males and 7 females. The mean oxygenation index PaO CONCLUSION: In patients with moderate-to-severe ARDS, both iNO and PP are beneficial for improving V/Q matching and oxygenation. However, no combined effect of iNO and PP was observed.

BACKGROUND: ARDS affects a significant proportion of ventilated ICU patients and carries high mortality, especially in cases of severe hypoxemia unresponsive to standard treatments and ineligible for extracorporeal membrane oxygenation (ECMO). In such situations, care often shifts to comfort measures due to limited data and structured guidance. To address this gap, Massachusetts General Hospital established the Lung Rescue Team (LRT), a multidisciplinary group using advanced physiological tools to provide individualized, real-time management beyond protocolized care. OBJECTIVE: To evaluate the feasibility and application of a complex, physiology-guided framework in patients with severe hypoxemia who had not responded to standard or advanced interventions and were ineligible for rescue therapies such as ECMO, population typically excluded from clinical trials and often regarded as beyond curative treatment. DESIGN: This single-center, retrospective observational study included adult patients in the intensive care unit (ICU ( RESULTS: LRT consultation led to changes in respiratory management in 82.3% of patients who had already attend to receive maximal therapy, most commonly adjustments to PEEP based on EIT or transpulmonary pressure. The median ICU length of stay was 18.5 days (IQR 10.5–31.5). Survival was 48.3% at 90 days and 44.8% at 1 year. The leading cause of death was multiorgan failure (50%), followed by hypoxemia (25%) and unresponsive shock (25%). CONCLUSIONS: This study describes the experience of a physiology-guided, multidisciplinary LRT in patients with severe hypoxemia ineligible for ECMO, individuals often excluded from clinical trials and frequently considered beyond curative treatment. Survival in this cohort was far from negligible, highlighting the value of systematic re-evaluation rather than premature transition to palliation. Although causal inferences cannot be drawn from this retrospective, single-center analysis, the findings provide insight into an underreported population and generate hypotheses for future prospective studies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-025-05709-9.