Daily Ards Research Analysis
A large multicenter RCT in JAMA found that intraoperative driving pressure–guided high PEEP with recruitment maneuvers did not reduce postoperative pulmonary complications versus standard low PEEP, and increased hypotension. A real-world MIMIC-IV cohort of 3,869 sepsis-associated ARDS patients showed persistent hyperglycemia trajectories were associated with higher short- and long-term mortality. A Chinese ICU cohort comparing modified midline catheters to central venous catheters found fewer lo
Summary
A large multicenter RCT in JAMA found that intraoperative driving pressure–guided high PEEP with recruitment maneuvers did not reduce postoperative pulmonary complications versus standard low PEEP, and increased hypotension. A real-world MIMIC-IV cohort of 3,869 sepsis-associated ARDS patients showed persistent hyperglycemia trajectories were associated with higher short- and long-term mortality. A Chinese ICU cohort comparing modified midline catheters to central venous catheters found fewer local complications with midlines but a markedly higher removal rate.
Research Themes
- Perioperative lung-protective ventilation strategies
- Glycemic trajectory and prognosis in sepsis-associated ARDS
- Vascular access selection and complications in ICU care
Selected Articles
1. Intraoperative Driving Pressure-Guided High PEEP vs Standard Low PEEP for Postoperative Pulmonary Complications.
In 1,435 high-risk adults undergoing open abdominal surgery, driving pressure–guided high PEEP with recruitment maneuvers did not reduce postoperative pulmonary complications versus standard low PEEP (19.8% vs 17.4%; absolute difference 2.5%, 95% CI -1.5% to 6.4%; P=.23). High PEEP increased intraoperative hypotension and vasoactive use, while desaturation events were fewer with high PEEP.
Impact: This large, rigorous RCT provides definitive evidence that individualized high PEEP with recruitment does not improve clinical outcomes and may worsen hemodynamics, directly informing perioperative ventilation guidelines.
Clinical Implications: Standard low PEEP with low tidal volume should remain the default during open abdominal surgery; avoid routine high PEEP–recruitment strategies targeting lower driving pressure due to lack of benefit and increased hypotension. If high PEEP is considered, ensure vigilant hemodynamic monitoring and individualized risk assessment.
Key Findings
- Primary composite pulmonary complications within 5 days: 19.8% (high PEEP) vs 17.4% (low PEEP); absolute difference 2.5% (95% CI -1.5% to 6.4%); P=.23
- Intraoperative hypotension and vasoactive agent use were higher with high PEEP (hypotension 54.0% vs 45.0%; vasoactive use 32.0% vs 18.8%)
- Intraoperative desaturation events were fewer in the high PEEP group (0.8% vs 2.8%)
Methodological Strengths
- Multicenter randomized clinical trial with large sample size
- Registered trial with prespecified outcomes and standardized low tidal volume ventilation in both arms
Limitations
- Open-label design and composite primary outcome may dilute specific effects
- Generalizability to laparoscopic or non-abdominal surgeries and long-term pulmonary outcomes is uncertain
Future Directions: Identify subgroups that may benefit or be harmed by higher PEEP and test pragmatic hemodynamic-guided ventilation strategies balancing oxygenation and perfusion.
2. [Relationship between blood glucose trajectory during intensive care unit stay and mortality in patients with sepsis-associated acute respiratory distress syndrome].
Using MIMIC-IV and group-based trajectory modeling in 3,869 sepsis-associated ARDS patients, three 7-day glucose trajectories were identified: low-normal (6.1–7.0 mmol/L), moderate (7.8–8.9), and persistent hyperglycemia (10.6–13.1). Persistent hyperglycemia was associated with significantly higher 28-day and 1-year mortality compared with lower trajectories after adjustment.
Impact: Trajectory-based glycemic phenotyping links dynamic hyperglycemia to mortality in sepsis-associated ARDS, prioritizing targets for interventional trials and individualized glucose management.
Clinical Implications: Avoid persistent hyperglycemia in sepsis-associated ARDS; implement frequent monitoring and protocols to maintain glucose in lower target ranges while minimizing hypoglycemia. Findings should inform design of RCTs testing trajectory-guided glycemic control.
Key Findings
- Three 7-day glucose trajectories identified via GBTM: low-normal (6.1–7.0 mmol/L; n=1,523), moderate (7.8–8.9; n=1,452), persistent hyperglycemia (10.6–13.1; n=894)
- Persistent hyperglycemia trajectory showed significantly higher 28-day and 1-year mortality than lower trajectories
- Associations persisted after multivariable adjustment; hypoglycemia incidence across groups was assessed
Methodological Strengths
- Large real-world cohort with daily glucose data and advanced group-based trajectory modeling
- Adjusted analyses and survival comparisons (Kaplan–Meier) across phenotyped glucose trajectories
Limitations
- Retrospective single-database study with potential residual confounding and missing data bias
- Glycemic management protocols and insulin dosing heterogeneity not standardized
Future Directions: Prospective trials testing trajectory-guided glycemic targets in sepsis-associated ARDS and mechanistic studies of glucose variability, inflammation, and lung injury.
3. [A real-world study on the application of modified midline catheter and central venous catheter in medical intensive care unit].
In 274 ICU patients (MMC n=52; CVC n=222), MMC use was more common in ARDS, cardiovascular disease, and cancer, whereas CVCs were preferred for vasoactive infusions. MMCs had higher partial/complete removal (36.5% vs 5.4%) but lower puncture-site leakage, skin allergy, and DVT; longer indwelling time (≥12 days) and MMC use independently predicted removal.
Impact: Pragmatic real-world data suggest modified midlines can reduce several local catheter complications compared with CVCs, informing device selection and complication mitigation strategies in ICU patients with ARDS and other comorbidities.
Clinical Implications: Consider modified midline catheters when prolonged peripheral access is appropriate and vasoactive infusions are not required, while implementing measures to prevent accidental or premature removal. Maintain vigilance for DVT and local site issues regardless of device.
Key Findings
- MMC group had higher rates of ARDS, cardiovascular disease, and cancer compared with CVC group; CVCs used more often when vasoactive infusion was needed
- Partial/complete catheter removal was higher with MMC (36.5% vs 5.4%), while leakage (1.9% vs 22.1%), skin allergy (0% vs 20.7%), and DVT (3.8% vs 16.7%) were lower
- Independent predictors of removal: MMC use (OR 8.518, 95% CI 3.710–19.560) and indwelling time ≥12 days (OR 3.133, 95% CI 1.297–7.567)
Methodological Strengths
- Consecutive real-world ICU cohort with multivariable logistic regression
- Systematic comparison of device indications, dwell time, and a spectrum of complications
Limitations
- Single-center retrospective design with potential selection bias and limited generalizability
- Small MMC sample size limits precision; unmeasured confounders (e.g., nursing protocols) possible
Future Directions: Prospective multicenter studies and pragmatic trials to optimize device selection algorithms and standardized protocols to minimize removal while preserving the complication advantages of modified midlines.