Daily Ards Research Analysis

OBJECTIVE: The primary objective of this study was to evaluate sedation depth using processed electroencephalography (pEEG) in adults with acute respiratory distress syndrome (ARDS) receiving continuous neuromuscular blockade (NMBA). SECONDARY OBJECTIVES INCLUDED: (1) to estimate the prevalence of potential inadequate and excessive sedation; (2) to describe 24-hour temporal trends in Patient State Index (PSI) and spectral edge frequency (SEF; right [SEF-R] and left [SEF-L]) (T0-T24); and (3) to explore associations with sedative regimens. DESIGN: Prospective observational study. SETTING: Tertiary intensive care unit (ICU). PARTICIPANTS: Sixty adult patients with ARDS receiving continuous NMBA infusions for at least 24 hours. INTERVENTIONS: Sedation was achieved with propofol and/or midazolam, with fentanyl used as an analgesic adjunct. pEEG monitoring was applied using PSI, SEF-R, and SEF-L. MEASUREMENTS AND MAIN RESULTS: PSI, SEF-R, and SEF-L values were recorded at seven time points over 24 hours (T0-T24). PSI values were categorized as deep (<25), adequate (25-50), and potentially inadequate (>50) sedation. The median PSI value was 53.3; 50% of patients had a PSI >50, and 16.7% had a PSI >75, indicating potentially inadequate sedation despite continuous infusion. No significant hemodynamic differences were observed between adequately and inadequately sedated patients. Patients receiving propofol plus midazolam had significantly lower PSI values compared with those in the single-agent groups (p < 0.001). Across predefined time points (T0-T24), PSI decreased significantly from T0 to subsequent time points (overall p < 0.001), and SEF-R and SEF-L also showed significant time effects; pairwise comparisons involving T0 were consistently significant (see Supplementary Table 1). CONCLUSIONS: Among paralyzed ICU patients receiving NMBA, a substantial proportion demonstrated indices consistent with potential inadequate sedation despite standard protocols; explicit awareness was not assessed. pEEG monitoring should be interpreted cautiously and as an adjunct to clinical assessment, it may provide real-time information to support individualized, brain-focused sedation management.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is an important intervention for severe respiratory failure, yet coagulation abnormalities and circuit thrombosis remain significant challenges. Circuit exchanges are frequently performed to restore oxygenator function and mitigate ECMO-related coagulopathies, but optimal criteria for their indication remain unclear. METHODS: This retrospective analysis included adult patients with coronavirus disease 2019 associated acute respiratory distress syndrome (ARDS) receiving venovenous (VV) ECMO at a tertiary hospital between January 2020 and April 2023. The primary endpoint was the change in d-dimer level on the third day after a circuit exchange compared to the last value before the circuit exchange. Secondary analyses included parameters such as fibrinogen, platelet count, LDH, post‑oxygenator pO RESULTS: Among 48 patients, 37 (77.1 %) underwent at least one coagulation-related circuit exchange, totalling 96 exchanges. D-dimer levels significantly decreased from 19 μg/ml (IQR 11-25) before exchange to 4 μg/ml (IQR 2-7) after exchange (p < 0.001). Platelet counts increased significantly (p = 0.024), while LDH levels decreased (p = 0.001). No significant changes were observed in fibrinogen levels. A sharp increase in d-dimer prior to exchange correlated with subsequent decreases post-exchange (R = -0.66, p < 0.001). CONCLUSIONS: ECMO circuit exchanges are associated with significant improvements in coagulation parameters, particularly d-dimer reduction, suggesting that d-dimer trends may serve as a key indicator for elective circuit replacement. Future prospective studies should refine exchange criteria to optimize patient outcomes while minimizing unnecessary interventions.

BACKGROUND: Patients with severe trauma are at high risk of developing life-threatening complications, including acute respiratory failure and circulatory collapse. Extracorporeal membrane oxygenation (ECMO) offers critical support when conventional therapies fail. This narrative review aimed to analyze the clinical application of ECMO in patients with severe trauma, focusing on indications, complications, prognostic factors, and future directions. METHODS: A comprehensive literature search was conducted to identify studies published between January 2000 and April 2025. Sources included original research articles, systematic reviews, and meta-analyses, supplemented by relevant clinical guidelines and expert consensus statements pertaining to ECMO use in trauma care. RESULTS: Veno-venous ECMO has been primarily utilized in patients with trauma-associated acute respiratory distress syndrome, while veno-arterial ECMO has been employed in the management of cardiogenic shock and cardiac arrest. Reported survival rates were 72.3% for veno-venous ECMO and 39.0% for veno-arterial ECMO. ECMO has also been used in patients with traumatic brain injury and those undergoing extracorporeal cardiopulmonary resuscitation, although randomized controlled trial data remain limited Major complications include infection, hemorrhage, and thrombosis, which require coordinated prevention and management strategies. Prognostic tools such as the New Injury Severity Score, Simplified Acute Physiology Score III, and Sequential Organ Failure Assessment score are used in clinical evaluation, though trauma-specific models are still lacking. CONCLUSION: ECMO offers a supportive treatment modality in the management of patients with severe trauma. To improve clinical outcomes, further development of trauma-specific decision tools, multicenter studies, and standardized protocols for anticoagulation and infection control is necessary to support individualized care.