Daily Ards Research Analysis
Analyzed 10 papers and selected 3 impactful papers.
Summary
A pragmatic neonatal RCT shows a low-cost orogastric thin-catheter strategy for surfactant delivery reduces subsequent mechanical ventilation versus the InSurE method without added complications. Observational data from MIMIC-IV identify low Braden Skin Score at ICU admission as an independent predictor of ARDS and mortality in elderly sepsis, while a burn ICU cohort study delineates ARDS epidemiology and mortality risk factors to guide triage and management.
Research Themes
- Low-cost innovations for respiratory support in resource-limited settings
- Risk stratification for ARDS in elderly sepsis
- ARDS epidemiology and prognosis in burn patients
Selected Articles
1. Effectiveness and feasibility of orogastric tube for surfactant delivery in moderate or very preterm neonates with respiratory distress syndrome: an open-label randomized controlled trial.
In an open-label RCT of preterm neonates with RDS, surfactant delivery via an orogastric feeding tube used as a thin tracheal catheter under CPAP reduced the need for mechanical ventilation versus InSurE, with 100% first-attempt success and no procedural complications. Safety outcomes and major morbidities were similar between groups.
Impact: This trial provides a feasible, low-cost alternative to InSurE with reduced ventilation needs, directly addressing access barriers in LMICs and potentially standardizing minimally invasive surfactant delivery.
Clinical Implications: Clinicians can consider thin-catheter orogastric surfactant delivery under CPAP as a practical alternative to InSurE, especially in resource-limited settings, to reduce intubation and mechanical ventilation.
Key Findings
- 100% first-attempt success for orogastric thin-catheter surfactant delivery without premedication or procedural bradycardia, desaturation, or apnea.
- Reduced need for mechanical ventilation compared with InSurE (22 vs 35; P=.049; RR 0.74).
- No significant differences in BPD, IVH (grade II+), air leaks, sepsis, oxygen duration, hospital stay, or mortality.
Methodological Strengths
- Randomized controlled design with an active comparator (InSurE).
- Pragmatic, bedside technique under CPAP with clinically meaningful endpoints.
Limitations
- Open-label design and unclear blinding could introduce performance bias.
- Sample size per group and multicenter generalizability are not detailed in the abstract.
Future Directions: Confirm efficacy in multicenter trials, compare with standardized LISA techniques, and evaluate long-term neurodevelopmental and pulmonary outcomes.
To assess the feasibility and effectiveness of administering surfactant via an orogastric feeding tube used as a thin tracheal catheter, compared with the Intubation-Surfactant-Extubation (InSurE) method, in preterm neonates with respiratory distress syndrome (RDS). This was hospital-based, randomized controlled trial. The intervention group (Group A) received surfactant via an orogastric tube with direct laryngoscopy while maintaining continuous positive airway pressure (CPAP) therapy. The control group (Group B) received surfactant using the standard InSurE technique. Data collected included demographic details, feasibility criteria, clinical condition, respiratory support requirements, complications, and final outcomes. Baseline characteristics were comparable between groups. All 120 infants in the intervention group received surfactant via the feeding tube successfully on the first attempt, with uninterrupted administration, no premedication, no conversions to intubation, no procedure-related bradycardia, desaturation, or apnea, and no significant regurgitation. The need for mechanical ventilation was significantly lower in the feeding-tube group compared with InSurE (22 vs. 35; P = .049, relative risk 0.74). The mean duration of oxygen therapy, hospital stay, rates of bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH) (grade II or higher), air leaks, sepsis, and mortality did not differ significantly between groups. Surfactant administration via an orogastric feeding tube inserted into the trachea is feasible, safe, and as effective as the InSurE method in preterm neonates of 28-34 weeks' gestation. This low-cost, universally available alternative has important implications for improving access to surfactant therapy in resource-limited settings of tropical low- and middle-income countries (LMICs).
2. The relationship between Braden Skin Score (BSS) and the risk of acute respiratory distress syndrome in elderly sepsis patients: An analysis based on the MIMIC-IV database.
Using the MIMIC-IV database, lower Braden Skin Score at ICU admission independently predicted ARDS development and higher in-hospital mortality among elderly sepsis patients. The findings suggest a simple, routinely collected score may aid early risk stratification.
Impact: Repurposes a ubiquitous nursing assessment tool for ARDS risk prediction in a vulnerable population, potentially enabling earlier preventive strategies without additional cost.
Clinical Implications: In elderly sepsis patients, incorporating BSS into risk assessments could flag those at higher ARDS risk for closer monitoring, diagnostic workup, and timely preventive measures.
Key Findings
- Lower Braden Skin Score at ICU admission was significantly associated with increased ARDS incidence among elderly sepsis patients.
- Lower BSS was also linked to higher in-hospital mortality in this population.
- Association persisted after multivariable adjustment using logistic regression models.
Methodological Strengths
- Use of a large, granular ICU database (MIMIC-IV) reflecting real-world practice.
- Multivariable logistic regression to adjust for confounding.
Limitations
- Retrospective design with potential residual confounding and misclassification.
- Exact sample size and external validation are not detailed in the abstract.
Future Directions: Prospective validation and integration of BSS into ARDS prediction models, with assessment of intervention thresholds and impact on outcomes.
OBJECTIVE: The Braden Skin Score (BSS) is a validated tool for assessing pressure injury risk. This study aimed to investigate whether BSS can also predict the risk of developing Acute Respiratory Distress Syndrome (ARDS) in elderly sepsis patients in the intensive care unit (ICU). BACKGROUND: ARDS is a common and serious complication in ICU patients with sepsis, associated with prolonged hospitalization, metabolic disorders, and increased mortality. Elderly sepsis patients are particularly vulnerable to pressure injuries due to prolonged bed rest. Nevertheless, the relationship between BSS and the risk of developing ARDS in this population has not been extensively studied. METHODS: Elderly sepsis patients from the MIMIC-IV database were chosen and partitioned into quartiles of BSS values. Although the incidence of ARDS was the primary endpoint, hospital mortality in the ARDS subgroup was the secondary endpoint. The correlation between low BSS and risk of ARDS and in-hospital mortality in elderly sepsis patients was assessed using logistic regression models. RESULTS: Multivariate logistic regression analysis revealed that a lower BSS at ICU admission was significantly associated with an increased risk of ARDS and higher in-hospital mortality among elderly sepsis patients. CONCLUSION: This study demonstrates that a low BSS at ICU admission is associated with a greater risk of ARDS and higher in-hospital mortality in elderly sepsis patients.
3. [Acute Respiratory Distress Syndrome in Burns: Epidemiology and Factors Associated with Mortality].
In a 4-year burn ICU cohort, 28% of intubated patients developed ARDS with high mortality (61%). Independent mortality predictors included TBSA >39%, higher IGSII and APACHE II scores, inhalation injury, and shock during resuscitation.
Impact: Defines the burden and prognosis of ARDS in burn patients and identifies actionable risk factors that can inform triage, monitoring, and early aggressive management.
Clinical Implications: Burn patients with large TBSA, high severity scores, inhalation injury, or shock warrant early ARDS-focused surveillance and escalation of care, including infection control and lung-protective strategies.
Key Findings
- Among 360 intubated burn patients, 100 (28%) developed ARDS; 60% severe and 40% moderate, with mean onset 5.8±4 days post-burn.
- Mortality was 61%; common complications included nosocomial infections (71%) and acute kidney failure (36%).
- Independent mortality predictors: TBSA >39% (p=0.02), IGSII >27 (p<10^-3), APACHE II >14.5 (p=0.01), inhalation injury (p<10^-3), and shock during resuscitation (p=0.04).
Methodological Strengths
- Defined ARDS by Berlin criteria with multivariable analysis for mortality predictors.
- Dedicated burn ICU cohort enabling detailed clinical characterization.
Limitations
- Single-center retrospective design with a modest ARDS sample size (n=100).
- Potential unmeasured confounding and limited data on ventilatory strategies and fluid management.
Future Directions: Prospective multicenter validation and integration of risk factors into predictive models to guide early intervention pathways in burn patients.
Acute respiratory distress syndrome (ARDS) is a common pathology in the intensive care unit associated with high mortality, especially in burn patients. A retrospective descriptive and univariate study was conducted in the intensive burn care unit over 4 years, from January 2018 to December 2021. Patients who developed ARDS during their stay according to the Berlin definition 2012 were included. One thousand one hundred and fifty patients were admitted, 360 were intubated (31%), of whom 100 presented an ARDS complication (28%). The average age was 40±13 years with a sex ratio of 1.8. The mean acute physiology and chronic health evaluation (APACHE) and severity simplified index (IGSII) were respectively 18(15-21) and ±34(29-42). The mean total body surface area burned was 46%±18, mean abbreviated burn severity index (ABSI) was 7,6±2,5. ARDS was severe among 60% (n=60) of cases and moderate in 40% (n=40) of cases, with a mean delay of occurrence from burns of 5.8±4 days. ARDS was due to infection in 56 patients, inhalation injury in 22 patients, and mixed etiology in 22 patients. The main complications observed were nosocomial infections among 71% of patients and acute kidney failure among 36% of patients. The mean duration of mechanical ventilation was 12,6±5,3 days and the mean length of stay in the intensive care unit was 13,7±5 days. Mortality was 61% (n=61). In multivariate analysis, independent mortality risk factors were identified: surface area burned greater than 39% (p=0,02), severity simplified index (IGSII) higher than 27 (p<10-3), APACHE II higher than 14,5 (p=0,01), the presence of pulmonary burns (p<10-3) and the occurrence of shock during resuscitation (p=0,04). Le syndrome de détresse respiratoire aiguë (SDRA) est une pathologie fréquente en réanimation, associée à une mortalité élevée. Nous avons mené une étude rétrospective descriptive monocentrique, dans le service de réanimation des brûlés, sur 4 ans (Janvier 2018-Décembre 2021), incluant les patients ayant présenté un SDRA, retenu selon la définition de Berlin de 2012. Mille cent cinquante patients ont été admis dans le service, 360 ont été intubés (31%) dont 100 ont présenté un SDRA (28%). L’âge moyen était de 40±13 ans avec un genre- ratio M/F de 1,8. L’IGS II et L’APACHE II moyens étaient respectivement de 34 (29-42) et 18 (15-21). La surface cutanée brûlée (SCB) moyenne était de 46±18%, le score ABSI moyen était de 7,6±2,5. Le SDRA était sévère dans 60% des cas et modéré dans 40% des cas. Le délai moyen de diagnostic par rapport aux brûlures était de 5,8±4 jours. Le SDRA était secondaire à une pneumonie nosocomiale dans 56% des cas, aux atteintes pulmonaires initiales dans 22% des cas et mixte dans 22% des cas. La durée moyenne de ventilation mécanique était de 12,6±5,3 jours et la durée moyenne de séjour était de 13,7±5 jours. La mortalité était de 61%. En analyse multivariée, les facteurs indépendants de mortalité étaient une SCB supérieure à 39% (p=0,02), un IGS II supérieur à 27 (p <10-