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.
IMPORTANCE: The effect of individualized high positive end-expiratory pressure (PEEP) and recruitment maneuvers, targeting a low driving pressure, on clinical outcomes in patients undergoing open abdominal surgery is uncertain. OBJECTIVE: To compare driving pressure-guided high PEEP and recruitment maneuvers with standard low PEEP without recruitment maneuvers with respect to postoperative pulmonary complications. DESIGN, SETTING, AND PARTICIPANTS: Randomized clinical trial of 1435 adults at increased risk for postoperative pulmonary complications who were scheduled for open abdominal surgery. The trial was conducted at 29 sites in 5 countries across Europe from April 2019 to December 2024; final follow-up was in March 2025. Statistical analysis was conducted in May 2025.
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.
OBJECTIVE: To explore the association between blood glucose trajectories within 7 days of intensive care unit (ICU) admission and mortality in patients with sepsis-associated acute respiratory distress syndrome (ARDS). METHODS: Based on the MIMIC-IV database, sepsis-associated ARDS patients with daily blood glucose monitoring data within 7 days of ICU admission were selected. Blood glucose trajectories were analyzed using group-based trajectory modeling (GBTM), and the optimal number of groups was determined based on the minimum Akaike information criterion (AIC), Bayesian information criterion (BIC), average posterior probability (AvePP), odds of correct classification (OCC), and proportion of group membership (Prop). Baseline characteristics including demographics, comorbidities, severity scores, vital signs, laboratory indicators within the first 24 hours of ICU admission, and treatments were collected. Kaplan-Meier survival curves were used to compare 28-day and 1-year survival across trajectory groups. Multivariate Logistic regression was performed to evaluate the associations between glucose trajectory groups and in-hospital mortality, ICU mortality. The incidence of hypoglycemia within 7 days in the ICU was analyzed among different groups. RESULTS: A total of 3 869 patients with sepsis-associated ARDS were included, with a median age of 63.52 (52.13, 73.54) years; 59.6% (2 304/3 869) were male. Based on glucose levels within 7 days, patients were categorized into three groups: persistent hyperglycemia group (glucose maintained at 10.6-13.1 mmol/L, n = 894), moderate glucose group (7.8-8.9 mmol/L, n = 1 452), and low-normal glucose group (6.1-7.0 mmol/L, n = 1 523). There were statistically significant differences in 28-day mortality and 1-year mortality among low-normal glucose group, moderate glucose group, and persistent hyperglycemia group [28-day mortality: 11.42% (174/1 523), 19.83% (288/1 452), 25.50% (228/894), χ CONCLUSIONS: Blood glucose trajectories during ICU stay are closely associated with prognosis in patients with sepsis-associated ARDS. Persistent hyperglycemia (10.6-13.1 mmol/L) is linked to significantly higher short- and long-term mortality.
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.
OBJECTIVE: To investigate the differences in indwelling duration, clinical scenarios, and complications between the modified midline catheter (MMC) and the central venous catheter (CVC) in the treatment of patients in the medical intensive care unit (ICU) and the risk factors for complications based on real-world data. METHODS: A retrospective cohort study was conducted. The adult patients admitted to the medical ICU of the Third Xiangya Hospital of Central South University and had undergone placement of either a MMC or a CVC between January 1, 2023, and July 31, 2024, were consecutively enrolled by querying the hospital's electronic medical record system. Based on the type of catheter inserted, the patients were divided into the MMC group and the CVC group. The two groups were compared regarding the selection of catheters in the context of different underlying diseases, the actual clinical application after catheterization, catheter-related complications, the international normalized ratio (INR) and platelet count (PLT) during puncture and catheterization, the length of ICU stay, total length of hospital stay, catheter indwelling duration, and mortality during hospitalization. Multivariate Logistic regression analysis was employed to identify independent risk factors for catheter removal. RESULTS: Among the 274 patients, 52 received a MMC and 222 received a CVC. The utilization rate of MMC was significantly higher than that of CVC in patients with acute respiratory distress syndrome (ARDS), cardiovascular disease, and cancer [ARDS: 92.3% (48/52) vs. 70.3% (156/222), cardiovascular disease: 84.6% (44/52) vs. 54.5% (121/222), cancer: 30.8% (16/52) vs. 17.1% (38/222), all P < 0.05]. However, the use of MMC was significantly lower than CVC when vasoactive drug infusion was required [57.7% (30/52) vs. 79.7% (177/222), P < 0.05]. A significantly higher proportion of patients in the MMC group had a catheter indwelling time ≥ 12 days as compared with the CVC group [32.7% (17/52) vs. 13.5% (30/222), P < 0.05]. There were no statistically significant differences in other underlying diseases, venous access usage, INR and PLT during puncture and catheterization, length of ICU stay, total length of hospital stay, and in-hospital mortality of patients between the two groups. Regarding catheter-related complications, although the incidence of partial or complete catheter removal in the MMC group was significantly higher than that in the CVC group [36.5% (19/52) vs. 5.4% (12/222), P < 0.05], the incidence of puncture site fluid leakage, puncture site skin allergy, and deep vein thrombosis were significantly lower than those in the CVC group [puncture site fluid leakage: 1.9% (1/52) vs. 22.1% (49/222), puncture site skin allergy: 0% (0/52) vs. 20.7% (46/222), deep vein thrombosis: 3.8% (2/52) vs. 16.7% (37/222), all P < 0.05]. Furthermore, the proportion of patients experiencing three or more types of complications in the MMC group was significantly lower than that in the CVC group [5.8% (3/52) vs. 17.6% (39/222), P < 0.05]. Multivariate Logistic regression analysis of risk factors for catheter removal identified the use of a MMC [odds ratio (OR) = 8.518, 95% confidence interval (95%CI) was 3.710-19.560, P < 0.001] and a catheter indwelling time ≥ 12 days (OR = 3.133, 95%CI was 1.297-7.567, P = 0.011) as independent risk factors. CONCLUSIONS: MMC was more frequently used in patients with ARDS, cardiovascular disease, and cancer, whereas CVC was primarily employed for vasoactive drug infusion. The use of MMC and a longer indwelling time were identified as independent risk factors for catheter removal. Despite a higher removal rate, the overall incidence of complications was significantly lower with MMC than with CVC. These findings suggest that MMC could serve as a routine alternative to CVC in most of clinical scenarios, provided that measures are implemented to prevent removal.