Daily Ards Research Analysis
Analyzed 10 papers and selected 3 impactful papers.
Summary
A mechanistic mouse study shows that macrophage IGF-1/IGF-1R signaling accelerates recovery from acute lung injury, spotlighting a pro-resolution pathway for ARDS. A meta-analysis of RCTs in extremely preterm infants finds no reduction in bronchopulmonary dysplasia with adding budesonide to pulmonary surfactant. A feasibility study suggests videolaryngoscopy-guided LISA may improve tolerability during surfactant delivery in preterm infants.
Research Themes
- ARDS pathophysiology and pro-resolution mechanisms
- Optimization of neonatal surfactant therapy
- Airway instrumentation innovations for less invasive neonatal care
Selected Articles
1. Insulin-like growth factor-1/insulin-like growth factor-1 receptor signalling in macrophages facilitates recovery from acute lung injury.
In LPS-induced murine acute lung injury, intratracheal IGF-1 administered during the recovery phase reduced inflammatory cell counts and lung injury scores, whereas IGF-1R antagonism worsened them. IGF-1R was highly expressed on macrophages (notably CD11c+), and macrophage-focused IGF-1 signaling emerged as a pro-resolution pathway.
Impact: Identifies a macrophage IGF-1/IGF-1R axis that actively promotes resolution of lung injury, advancing ARDS pathobiology beyond injury suppression toward recovery enhancement.
Clinical Implications: Suggests IGF-1/IGF-1R signaling as a therapeutic target to enhance resolution in ARDS; motivates biomarker and early-phase interventional studies focusing on timing, route, and macrophage-directed strategies.
Key Findings
- Intratracheal recombinant IGF-1 given from day 4 post-LPS reduced inflammatory cells and lung injury scores.
- IGF-1R antagonism with JB1 during recovery increased inflammation and injury metrics.
- IGF-1R (CD221) was strongly expressed on macrophages, especially CD11c+ populations, implicating macrophage IGF-1 signaling in lung repair.
Methodological Strengths
- Timed intervention during the recovery phase with both agonist and antagonist controls
- Use of in vivo acute lung injury model with cell-type expression profiling and adoptive cell approaches
Limitations
- Preclinical mouse model limits direct clinical generalizability
- Detailed sample sizes and off-target effects of JB1 are not described in the abstract
Future Directions: Validate IGF-1/IGF-1R macrophage signaling in human ARDS, define optimal dosing/timing/routes, and explore macrophage-targeted delivery or biomarkers to select responders.
BACKGROUND: No effective treatment strategy for acute respiratory distress syndrome (ARDS) has been established. Conflicting reports on the effects of insulin-like growth factor (IGF)-1 stimulation and the inhibition of IGF-1 receptor (IGF-1R) signalling in tissue injury across several organs have led to hesitation in advancing IGF-1-based treatment strategies for tissue damage. OBJECTIVE: We aim to examine whether IGF-1/IGF-1R signalling contributes to recovery from acute lung injury in mouse models and to further explore its potential mechanisms. METHODS: Lipopolysaccharide (LPS) was intratracheally injected into mice to create acute lung injury models. Experiments were conducted to acquire or inhibit IGF-1 signalling through the intratracheal injection of recombinant IGF-1 or JB1, an IGF-1 receptor antagonist during the recovery phase of the models, starting on day 4 after LPS administration. Bone marrow monocyte-derived macrophages (MDMs) cocultured with IGF-1 and/or JB1 were intratracheally injected during the recovery phase. RESULTS: Inflammatory cell counts and lung injury scores were significantly decreased when recombinant IGF-1 was administered in the later phase, while they increased with the administration of JB1. On day 4 after LPS injection, IGF-1 receptor (IGF-1R, also known as CD221) was strongly expressed on macrophages, particularly in CD11c CONCLUSION: IGF-1/IGF-1R signalling in macrophage facilitates the recovery from acute lung injury
2. Efficacy of pulmonary surfactant with budesonide in infants born at or less than 28 weeks' gestation: a systematic review and meta-analysis.
Across RCTs in extremely preterm infants (≤28 weeks’ GA), adding intratracheal budesonide to pulmonary surfactant did not significantly reduce BPD incidence versus surfactant alone. The analysis used random-effects models and GRADE assessment, supporting cautious interpretation and discouraging routine adoption of the combination solely for BPD prevention.
Impact: Provides trial-level synthesis that challenges growing off-label use of budesonide-surfactant mixtures by showing no BPD benefit in the highest-risk preterm population.
Clinical Implications: Clinicians should avoid routine addition of budesonide to surfactant for BPD prevention in extremely preterm infants and prioritize established strategies; further targeted trials may be needed before practice changes.
Key Findings
- No significant reduction in BPD incidence with surfactant plus budesonide versus surfactant alone (RR 0.96; 95% CI 0.86–1.08; p=0.51).
- Restricted to randomized controlled trials in infants ≤28 weeks’ gestation with random-effects meta-analysis.
- Quality of evidence was appraised using GRADE methodology.
Methodological Strengths
- Restriction to RCTs with random-effects modeling
- Formal evidence grading using GRADE across prespecified outcomes
Limitations
- The abstract does not report the number of included trials or heterogeneity statistics, limiting interpretability from the abstract alone
- Focus on ≤28 weeks’ GA may limit generalizability to later preterm infants
Future Directions: Conduct adequately powered RCTs to define optimal dosing, delivery, and target subgroups, and assess long-term neurodevelopmental outcomes with budesonide-surfactant.
Pulmonary surfactant (PS) is the standard treatment for respiratory distress syndrome in preterm infants. Budesonide, a corticosteroid with anti-inflammatory properties, has been studied for use with PS to potentially improve respiratory outcomes and reduce bronchopulmonary dysplasia (BPD) risk while minimizing systemic steroid exposure. This study aimed to compare the efficacy of PS with budesonide versus PS alone in infants born ≤ 28 weeks' gestational age (GA). A systematic review and meta-analysis was conducted by searching PubMed, Scopus, Embase, and the Cochrane Library databases from inception to October 21, 2025. Inclusion was restricted to randomized controlled trials (RCTs) examining PS with budesonide efficacy in extremely preterm populations. Risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models, and the quality of evidence was assessed with GRADE methodology. The primary outcomes were the incidence and severity of BPD; secondary outcomes included other respiratory measures, pre-discharge mortality, hospital stay duration, and complications related to prematurity. Compared to PS alone, PS with budesonide did not significantly reduce BPD incidence (RR, 0.96; 95% CI, 0.86 to 1.08; p = 0.51; I
3. Low invasive surfactant administration by videolaringoscopy: a feasibility study.
In 23 very preterm infants undergoing 25 LISA procedures, videolaryngoscopy allowed glottic visualization without apnea, bradycardia, or desaturation. Limited adverse events occurred during surfactant infusion, suggesting this approach is feasible and potentially safer than direct laryngoscopy-guided LISA.
Impact: Introduces a practical airway visualization adjunct to LISA that may reduce physiologic instability during surfactant delivery in vulnerable preterm infants.
Clinical Implications: NICUs may consider videolaryngoscopy to guide thin-catheter placement during LISA to improve procedural tolerability; comparative trials are needed before broad adoption.
Key Findings
- Among 23 infants (25 procedures), no apnea, bradycardia, or desaturation occurred during glottic visualization with videolaryngoscopy.
- During surfactant administration, 2 bradycardia episodes, 8 desaturation episodes, and 1 reflux event were observed.
- Adverse events appeared fewer than previously reported with direct laryngoscopy-guided LISA, supporting feasibility and safety.
Methodological Strengths
- Prospective feasibility assessment with predefined adverse event monitoring
- Use of videolaryngoscopy to standardize glottic visualization and catheter placement
Limitations
- Small single-center cohort without a randomized comparator arm
- Short-term outcomes only; effectiveness versus standard LISA not established
Future Directions: Conduct randomized or pragmatic comparative studies of videolaryngoscopy-guided LISA versus standard LISA, including physiologic stability, intubation avoidance, and long-term outcomes.
BACKGROUND: Less invasive surfactant administration (LISA) is a gentle emerging technique for surfactant administration through a thin catheter in infants receiving noninvasive ventilation. It seems to offer some advantages to very preterm infants. The purpose of the FRee of Invasiveness & Neonatal Delicate LISA (FRI&NDLI) study was to evaluate the feasibility and safety of using videolaryngoscopy for positioning the thin catheter tip beyond the vocal cords. METHODS: We studied preterm infants with 24 RESULTS: Twenty-three infants with 28.9 ± 2.8 weeks of gestational age and a birth weight of 1255 ± 458 g who received 25 procedures were studied. No episodes of apnoea, bradycardia, or desaturation were recorded during the glottis visualization in videolaryngoscopy. Two episodes of bradycardia, 8 episodes of desaturation, and 1 episode of surfactant reflux were observed during surfactant administration. CONCLUSION: We found that the FRI&NDLI procedure was safe and associated with less adverse effects than previously reported for LISA procedure using direct laringoscopy. Our findings support the possibility of planning further studies to compare the effectiveness of FRI&NDLI and LISA procedure for surfactant administration in preterm infants.