Daily Ards Research Analysis
Analyzed 10 papers and selected 3 impactful papers.
Summary
Three studies advance ARDS-related care across support, biomarkers, and bedside monitoring: a contemporary ELSO registry analysis characterizes outcomes and prognostic drivers for venopulmonary ECLS, a prospective cohort identifies extracellular NAMPT as an early predictor of severe organ dysfunction and mortality in ARDS, and a blinded prospective study shows BIVA outperforms cumulative fluid balance for hyperhydration assessment and associates low phase angle with mortality.
Research Themes
- ECMO/ECLS outcomes and prognostic stratification in ARDS
- Biomarker-driven risk prediction in ARDS
- Noninvasive fluid status monitoring at the bedside
Selected Articles
1. VENOPULMONARY EXTRACORPOREAL LIFE SUPPORT: AN ELSO REGISTRY ANALYSIS.
In 838 adults supported with venopulmonary ECLS, 60-day mortality was approximately 49%, with frequent complications such as AKI/CRRT use and infections. Outcomes and complication patterns differed by indication, and younger age, male sex, lower BMI, and absence of pre-cannulation CRRT were associated with lower mortality risk.
Impact: This contemporary registry provides the largest real-world characterization of venopulmonary ECLS, including ARDS, and identifies modifiable clinical domains for quality improvement and future trials.
Clinical Implications: For ARDS requiring advanced extracorporeal support, these data support risk stratification and surveillance for high-frequency complications (renal injury, infections) and inform patient selection and timing of cannulation.
Key Findings
- Among 838 VP ECLS cases, ARF/ARDS accounted for 26.6% of indications.
- Kaplan–Meier estimated 60-day mortality was 49.3% (45.3–53.1).
- Complications were common: CRRT/AKI 37.4%, infections 35.4%, arrhythmias 13.5%, surgical site bleeding 12.1%, GI bleeding 6.1%.
- Younger age, male sex, lower BMI, and no pre-cannulation CRRT were associated with lower mortality risk.
- Patterns of complications and outcomes differed across diagnostic groups.
Methodological Strengths
- Large, contemporary multicenter registry with diverse indications
- Time-to-event Cox modeling and subgroup reporting by diagnosis
Limitations
- Retrospective registry design with potential selection and measurement biases
- Heterogeneity across indications limits ARDS-specific causal inference
Future Directions: Prospective, indication-specific studies (including ARDS) are needed to optimize cannulation strategies, mitigate complications, and test prognostic enrichment for interventional trials.
BACKGROUND: There is a paucity of data informing on the current use, adverse events, outcomes, and prognostic drivers for patients receiving venopulmonary extracorporeal life support (VP ECLS). We aimed to provide a contemporary, large sample size study to describe the real-world outcomes of adults supported with VP ECLS across different clinical conditions. METHODS: We queried the Extracorporeal Life Support Organization (ELSO) Registry to retrieve all adult patients who received VP ECLS as the first support modality from July 2020 to July 2024. Study population was grouped according to hospital death outcome and to the diagnosis leading to VP ECLS use. Adverse outcomes are reported according to primary diagnosis leading to VP ECLS use. A time-to-event Cox regression model was applied to identify predictors of death. RESULTS: A total of 838 patients [32.3% females; age 8 (46, 67) years] were included. Patients were treated for heart failure/cardiogenic shock (HF/CS) in 54.4%, for acute respiratory failure/acute respiratory distress syndrome (ARF/ARDS) in 26.6%, for post-cardiotomy shock in 6.7%, for acute coronary syndrome/ischemic heart disease in 5.3%, for valvular heart disease/complications of intracardiac devices in 4.2%, and for pulmonary embolism in 2.9%. Most common adverse events included continuous renal replacement therapy (CRRT) use or acute kidney injury (37.4%), infections (35.4%), cardiac arrhythmias (13.5%), surgical site bleeding (12.1%), gastrointestinal (GI) bleeding (6.1%). Complications were more common in non-survivors and patterns of complications differed among diagnosis groups. The Kaplan-Meier estimated 60-day mortality was 49.3 (45.3, 53.1)%. Age (HR CONCLUSIONS: In this large ELSO registry analysis, VP ECLS was chiefly used for HF/CS and ARF/ARDS. Hospital outcomes, complications and survival differed according to the diagnosis leading to VP ECLS use. Younger age, male sex, lower BMI, and no CRRT use prior to VP ECLS cannulation confer a lower risk of death and provide targets for future research and potential domains for clinical improvement.
2. Utility of Extracellular Nicotinamide Phosphoribosyl Transferase as a Novel Biomarker in Predicting Early Severe Organ Dysfunction and Mortality in Acute Respiratory Distress Syndrome: A Prospective Observational Study.
In 90 ARDS patients, plasma extracellular NAMPT ≥4.38 ng/mL predicted early severe organ dysfunction and was associated with ICU mortality and shorter survival. Findings support eNAMPT as a prognostic biomarker aligned with a mechanistically plausible target.
Impact: This prospective study links a mechanistically relevant cytozyme to early organ failure and mortality in ARDS, advancing biomarker-based risk stratification and potential therapeutic targeting.
Clinical Implications: eNAMPT may aid early triage and monitoring in ARDS, identifying high-risk patients for intensified care and for enrichment in trials of NAMPT-pathway modulation.
Key Findings
- Plasma eNAMPT predicted early severe organ dysfunction in ARDS (adjusted OR 1.343; 95% CI 1.105–1.634).
- A threshold of ≥4.38 ng/mL identified patients at higher risk.
- Higher eNAMPT levels were associated with ICU mortality and shorter survival.
- Collection included oxygenation, inflammatory markers, lung ultrasound, and ventilatory mechanics for contextualization.
Methodological Strengths
- Prospective observational design with multivariable adjustment
- Mechanistically grounded biomarker with predefined threshold reporting
Limitations
- Single-center study with modest sample size and no external validation
- Cut-off derived internally; lack of serial eNAMPT kinetics
Future Directions: External validation, serial measurements to assess kinetics, and interventional studies targeting the NAMPT pathway are warranted.
BACKGROUND AND AIM: Nicotinamide phosphoribosyl transferase (NAMPT) is an upstream cytozyme (cytokine plus enzyme) with unique features, having intracellular NAMPT (iNAMPT) and extracellular NAMPT (eNAMPT) components. Genetic associations and therapeutic inhibition highlight its potential as both a biomarker and therapeutic target. We aimed to study the utility of eNAMPT as a predictor of severe organ dysfunction and its association with mortality in acute respiratory distress syndrome (ARDS). PATIENTS AND METHODS: This is a single-center, prospective observational study involving 90 patients with ARDS. We noted plasma eNAMPT levels, oxygenation levels, inflammatory markers, lung ultrasound scores, driving pressures, and echocardiography parameters. Severity of organ dysfunction and ICU mortality were the outcomes. RESULTS: Plasma eNAMPT was found to be a predictor of severe organ dysfunction in ARDS [adjusted OR: 1.343, 95% CI (1.105-1.634), CONCLUSION: Plasma eNAMPT (≥4.38 ng/mL) predicts early severe organ dysfunction in ARDS patients. It is also associated with mortality and a shorter median survival time. HOW TO CITE THIS ARTICLE: Rao S, Srinivas T, Parampalli V, Todur P, Udupa AA, Rao S,
3. Bioelectrical Impedance in Monitoring Hyperhydration and Muscle Wasting in Critically Ill Corona Virus Disease (COVID-19) Patients: The Feasibility of Predicting Outcome.
In a prospective, blinded cohort of 61 ventilated COVID-19 ARDS patients, BIVA feasibly quantified hyperhydration and outperformed cumulative fluid balance (significant ECW/TBW and OHY metrics). A lower phase angle was associated with higher mortality in non-ECMO patients, while ECMO use affected measurement accuracy.
Impact: This study supports a practical, noninvasive tool that can improve bedside fluid status assessment and mortality risk stratification where fluid balance metrics are unreliable.
Clinical Implications: BIVA can complement standard monitoring to guide de-resuscitation and avoid fluid overload in ARDS care; low phase angle may identify high-risk patients, especially outside ECMO.
Key Findings
- BIVA was feasible in critically ill ventilated COVID-19 ARDS patients, with measurements at 0, 7, and 14 days.
- BIVA-derived ECW/TBW and OHY identified hyperhydration with statistical significance (p=0.0050 and p=0.0402), outperforming cumulative fluid balance.
- Lower phase angle (median 3.3°) was associated with higher mortality in non-ECMO patients.
- ECMO use affected BIVA accuracy; BIVA did not reliably assess muscle mass.
Methodological Strengths
- Prospective, blinded observational design with trial registration (NCT04758676)
- Repeated measures allowing temporal assessment (baseline, day 7, day 14)
Limitations
- Single-center, modest sample size; primarily COVID-19 ARDS may limit generalizability
- Observational study without protocolized fluid management; ECMO interferes with accuracy
Future Directions: Multicenter validation and interventional trials testing BIVA-guided de-resuscitation in ARDS, including strategies to mitigate ECMO-related measurement artifacts.
Critically ill patients often experience hyperhydration and muscle wasting, which can worsen outcomes. This study evaluated the feasibility of using bioelectrical impedance vector analysis (BIVA) to monitor hydration and muscle mass and predict outcomes in COVID-19 patients with acute respiratory distress syndrome (ARDS), including those with extracorporeal membrane oxygenation (ECMO). The study compare fluid parameters derived from BIVA with cumulative fluid balance (CFB) and assess the prognostic value of the phase angle (PA) of BIVA against established markers such an APACHE II and serum presepsin. In this prospective, blinded observational study, 61 COVID-19 patients on invasive mechanical ventilation (IMV) were included. BIVA measurements were taken within 48 h of admission, then after 7 and 14 days. Data on demographics, fluid balance, and laboratory markers were collected. BIVA was shown to be feasible in critically ill patients, with a significant correlation between hyperhydration, defined by an elevated extracellular water to total body water ratio (ECW/TBW 0.56) and overhydration (OHY 6.9 l). Decreased PA (median 3.3°) was associated with increased mortality in non-ECMO patients. Unlike CFB, which lacked statistical significance, BIVA provided a more accurate assessment of hyperhydration (p=0.0050 for ECW/TBW and p=0.0402 for OHY). In conclusion, BIVA is a practical tool for monitoring hydration, but not muscle mass, in critically ill patients. Elevated hydration status and low PA measured by BIVA are effective predictors of mortality, although ECMO use can affect accuracy. ClinicalTrials.gov ID NCT04758676 (www.clinicaltrials.gov). Key words Bioelectrical impedance " Hyperhydration " Muscle mass " Critically ill patients " Mortality.