Daily Ards Research Analysis

BACKGROUND: Separation from venovenous extracorporeal membrane oxygenation (VV-ECMO) is a pivotal transition for patients with acute respiratory distress syndrome (ARDS). Impaired alveolar ventilation more so than oxygenation may be implicated in weaning failure. The ventilatory ratio (VR), a simple marker of patient ventilatory efficiency, correlates with physiological dead space and ARDS outcomes. We hypothesised that elevated VR measured during sweep gas off trials (SGOT) predicts unsafe liberation from VV-ECMO. METHODS: In this monocentric retrospective study, adult patients undergoing VV-ECMO for ARDS between July 2019 and August 2023 were recruited. Patients who died on ECMO or were palliatively separated were excluded. Physiological, ventilatory and ECMO data were extracted from the electronic medical record. VR was calculated as VE [minute ventilation] × PaCO₂/(predicted body weight × 100 × 37.5). Safe wean was defined as ECMO free survival without predefined "unsafe criteria" (hypoxia, hypercapnia with acidosis, escalations in mechanical ventilation, or haemodynamic deterioration) occurring during SGOT (sweep gas off trial) or within 48 h of ECMO separation. RESULTS: Thirty-nine patients (median age 47 years; 76.9% male) were included. Twenty-four patients separated safely from ECMO following a single SGOT, the remaining 15 patients underwent 36 unsafe trials before decannulation, 69.4% of which failed due to hypercapnia. Safe wean trials were longer (19 [5.7-25.0]hr vs. 5 [0.3-13.3]hr; p = 0.01) and preceded by lower fractional delivered oxygen (FdO CONCLUSIONS: Elevated ventilatory ratio during SGOT was associated with unsafe weaning from VV-ECMO in this retrospective cohort of patients with ARDS. Prospective validation is warranted to inform future weaning practice.

BACKGROUND: Neonatal respiratory distress syndrome (NRDS) is one of the most common respiratory diseases in the neonatal period and a major cause of neonatal mortality. Prolonged mechanical ventilation (MV) is associated with adverse outcomes in NRDS patients, highlighting the need for effective early risk stratification tools. The Neonatal Sequential Organ Failure Assessment (nSOFA) score has emerged as a potential predictor of adverse outcomes, but its association with prolonged MV remains unclear. METHODS: This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care III (MIMIC-III) database, analyzing 642 NRDS infants admitted to the neonatal intensive care unit (NICU) between 2001 and 2012. Patients were divided into two groups based on MV duration: prolonged MV (> 96 h) and non-prolonged MV (≤ 96 h). The highest nSOFA score within 24 h of admission was the primary exposure variable. Covariates included demographic data, clinical characteristics, and laboratory results. A multivariable logistic regression model was used to assess the association between nSOFA scores and prolonged MV. The predictive ability of nSOFA was evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS: Of the 642 NRDS infants, 192 (29.9%) required prolonged MV. Each 1-point increase in the nSOFA score was associated with a 29% higher risk of prolonged MV (odds ratio [OR]: 1.29; 95% confidence interval [CI]: 1.16-1.44; p < 0.001). The nSOFA score demonstrated moderate predictive ability (AUC: 0.7245; 95% CI: 68.41%-76.49%), which was significantly better than its respiratory sub-score (AUC: 0.6936; p < 0.001) and comparable to the SOFA score (AUC: 0.7218; p = 0.89). Using an nSOFA cutoff of 3, the sensitivity and specificity for predicting prolonged MV were 64.06% and 70.22%, respectively. CONCLUSION: The nSOFA score is an independent risk factor for prolonged MV in NRDS infants, with moderate predictive ability. Its simplicity and effectiveness make it a valuable tool for early risk stratification in NICUs. Future multicenter studies are needed to validate these findings and explore the potential of dynamic nSOFA monitoring in improving predictive accuracy.

OBJECTIVES: Acute respiratory distress syndrome remains a serious multifactorial complication after liver transplant, characterized by high mortality. Key determinants and risk factors for acute respiratory distress syndrome remain incompletely understood. MATERIALS AND METHODS: We retrospectively investigated risk factors for acute respiratory distress syndrome in 124 patients after living donor liver transplant between January 2018 and March 2025. We analyzed preoperative clinical information, intraoperative course characteristics, and patient parameters on admission to the intensive care unit after surgery, as well as complications and outcomes. Acute respiratory distress syndrome was diagnosed in accordance with the Berlin definition as the presence of acute hypoxemia, bilateral pulmonary infiltrates on chest radiography consistent with pulmonary edema, and respiratory failure not fully explained by cardiac dysfunction or fluid overload. We conducted multivariate logistic regression analysis to differentiate risk factors. RESULTS: Among the 124 analyzed patients, 16 (12.9%) were diagnosed with acute respiratory distress syndrome, predominantly within the first 24 hours. Preoperative presence of hepatopulmonary syndrome (odds ratio 6.86; P < .001), intraoperative high total red blood cell transfusion volume (odds ratio 1.90; P = .011), postoperative elevated white blood cell count (odds ratio 1.56; P = .020), neutrophil-to-lymphocyte ratio (odds ratio 2.00; P = .03), decreased Pao2 (odds ratio 0.93; P = .010), lower international normalized ratio (odds ratio 0.004; P = .027), total bilirubin concentration (odds ratio 1.01; P = .030), and serum albumin level (odds ratio 1.12; P = .006) were risk factors. Patients also experienced significantly higher rates of early postoperative complications, systemic disorders, prolonged mechanical ventilation and hospitalization, and hospital mortality (25%; P < .001). CONCLUSIONS: Acute respiratory distress syndrome after living donor liver transplant was associated with hepato-pulmonary syndrome, intraoperative large-volume red blood cell transfusion, postoperative white blood cells, neutrophil-to-lymphocyte ratio, Pao2, international normalized ratio, albumin, and total bilirubin.