Daily Ards Research Analysis
Analyzed 11 papers and selected 3 impactful papers.
Summary
Three impactful ARDS/ALI studies stood out today: a PROSPERO-registered meta-analysis suggesting reduced-intensity or no heparin during ECMO may lower bleeding without added thrombosis risk; a meta-analysis of RCTs indicating CRRT combined with ulinastatin improves short-term outcomes and reduces mortality in ARDS; and a prospective pediatric study validating lung ultrasound scores as correlates of severity and predictors of outcomes.
Research Themes
- Anticoagulation strategies during ECMO for ARDS/respiratory failure
- Adjunctive organ support and pharmacologic therapy in ARDS
- Point-of-care ultrasound biomarkers in pediatric acute respiratory failure
Selected Articles
1. Efficacy of reduced-intensity or no heparin versus standard heparin anticoagulation in patients on extracorporeal membrane oxygenation: a systematic review and meta-analysis.
This PRISMA-compliant, PROSPERO-registered meta-analysis of 11 studies (n=958) suggests that reduced-intensity or no heparin during ECMO may decrease bleeding without significantly increasing thrombosis. Findings apply across V-V and V-A ECMO cohorts and indicate potential improvements in patient outcomes.
Impact: Anticoagulation intensity during ECMO is a key modifiable factor for bleeding and thrombosis; synthesizing evidence toward safer strategies could influence ECMO protocols globally.
Clinical Implications: Clinicians may consider lower-intensity anticoagulation in selected ECMO patients—especially with high bleeding risk—with vigilant thrombotic monitoring and institutional protocol adjustments.
Key Findings
- Across 11 studies (n=958), reduced-intensity or no heparin strategies were feasible and safe during ECMO.
- Bleeding complications decreased without a significant increase in thrombotic events compared with standard anticoagulation.
- Findings were observed across V-V ECMO (respiratory failure/ARDS) and V-A ECMO cohorts.
- Review was PRISMA-compliant and PROSPERO-registered (CRD42025633878).
Methodological Strengths
- PRISMA-compliant methodology with PROSPERO registration
- Inclusion of both V-V and V-A ECMO populations enhancing generalizability
Limitations
- Predominantly non-randomized studies with heterogeneity in anticoagulation targets and monitoring
- Potential residual confounding and publication bias; incomplete reporting in some studies
Future Directions: Prospective, randomized trials comparing anticoagulation intensities and standardized monitoring protocols are needed, with subgroup analyses by ECMO modality and bleeding/thrombosis risk.
OBJECTIVE: This study aims to evaluate the efficacy of reduced-intensity or no heparin anticoagulation strategy in comparison to standard anticoagulation strategy during extracorporeal membrane oxygenation (ECMO) support. MATERIALS AND METHODS: Systematic literature review and meta-analysis, complying with the PRISMA guidelines (PROSPERO-CRD42025633878). RESULTS: Eleven studies comprising 958 patients were included in the analysis. Four studies included only patients treated with veno-venous extracorporeal membrane oxygenation (V-V ECMO) for acute respiratory distress syndrome or respiratory failure, two studies focused exclusively on patients treated with veno-arterial extracorporeal membrane oxygenation (V-A ECMO), and five studies included a mixture of patients with both modalities. Most studies ( CONCLUSION: Reduced-intensity or no heparin anticoagulation appears to be a feasible and safe strategy, demonstrating the potential to reduce bleeding complications without a significant increase in thrombotic events, and may be associated with improved patient outcomes. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025633878, identifier CRD42025633878.
2. Continuous renal replacement therapy combined with ulinastatin in acute respiratory distress syndrome: A systematic review and meta-analysis.
Across five RCTs (n=384), combining CRRT with ulinastatin reduced mortality (RR 0.37, 95% CI 0.23–0.60) and improved short-term physiologic and utilization outcomes versus CRRT alone in ARDS. Evidence quality is limited, warranting larger multicenter trials.
Impact: If validated, this low-cost, mechanistically plausible combination could become a scalable adjunctive therapy for ARDS, a condition with few effective pharmacologic options.
Clinical Implications: For ARDS patients already receiving CRRT, adding ulinastatin could be considered in settings where it is available, while awaiting confirmatory multicenter RCTs and safety profiling.
Key Findings
- Five RCTs (n=384) comparing CRRT+ulinastatin versus CRRT alone in ARDS were synthesized.
- Combination therapy significantly reduced mortality (RR 0.37, 95% CI 0.23–0.60).
- ICU length of stay, mechanical ventilation time, and 7-day APACHE II decreased; 7-day oxygenation index and PaO2 improved.
- Overall evidence quality was limited, indicating need for rigorous multicenter RCTs.
Methodological Strengths
- Included only randomized controlled trials across 11 English/Chinese databases
- Assessed multiple clinically relevant outcomes (mortality, ICU stay, ventilation time, physiologic indices)
Limitations
- Small sample sizes and variable quality of included RCTs; potential geographic concentration
- Heterogeneity in dosing regimens and timing; limited safety reporting
Future Directions: Conduct adequately powered, multicenter, placebo-controlled RCTs with standardized dosing, safety endpoints, and long-term outcomes to validate mortality benefit.
Acute respiratory distress syndrome (ARDS) is a severe clinical condition with high mortality, and effective adjunctive therapies remain limited. In recent years, continuous renal replacement therapy (CRRT) and ulinastatin have both been applied in ARDS management, but the clinical value of their combined use is still unclear. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy of CRRT combined with ulinastatin compared with CRRT alone in patients with ARDS. A comprehensive search of 11 English and Chinese databases was performed from inception to August 29, 2025. Randomized controlled trials enrolling adult patients with ARDS and comparing CRRT plus ulinastatin versus CRRT alone were included. Mortality was the primary outcome, and secondary outcomes included intensive care unit (ICU) length of stay, mechanical ventilation time (MVT), Acute Physiology and Chronic Health Evaluation II (APACHE II) score at 7 days, oxygenation index (OI) at 7 days, and partial pressure of oxygen (PaO₂) at 7 days. Five studies involving 384 patients met the inclusion criteria. Pooled analysis showed that combination therapy significantly reduced mortality (risk ratio [RR] = 0.37, 95% confidence interval [CI] 0.23-0.60), ICU length of stay, MVT, and APACHE II scores at 7 days, and significantly improved OI and PaO₂ at 7 days compared with CRRT alone. Overall, current evidence of limited quality suggests that CRRT combined with ulinastatin may improve short-term clinical outcomes in patients with ARDS. Future rigorous, large-scale, multicenter randomized controlled trials are essential to verify these findings.
3. Validation of Lung Ultrasound Score for Disease Severity and Outcomes in Pediatric Acute Respiratory Failure.
In a two-center prospective pediatric cohort (n=76), early global lung ultrasound scores differentiated ARDS/LRTI from controls, correlated with oxygenation and ventilatory parameters, and predicted fewer ventilator-free and ICU-free days at 28 days.
Impact: Validating LUS as an early severity and outcome marker supports wider adoption of bedside ultrasound to stratify risk and guide management in pediatric ARDS/acute respiratory failure.
Clinical Implications: Performing standardized LUS scoring within 24 hours may aid early risk stratification, inform ventilator strategies, and set expectations for resource utilization in PICU.
Key Findings
- Median global LUS scores at 24 hours differed significantly: ARDS 19 (IQR 12–24), LRTI 8 (IQR 2–11), controls 2 (IQR 0–6); p<0.001.
- LUS scores correlated with oxygen saturation index (r=0.67), SpO2/FiO2 (r=-0.63), mean airway pressure (r=0.63), PEEP (r=0.52), and dynamic compliance (r=-0.43).
- Higher LUS scores were associated with fewer ventilator-free days, fewer positive-pressure ventilation-free days, and fewer ICU-free days at 28 days (all p<0.001).
Methodological Strengths
- Prospective, two-center design with standardized timing for LUS assessments
- Evaluation of patient-centered outcomes (ventilator-free and ICU-free days)
Limitations
- Modest sample size and limited external generalizability
- Observational design without assessment of inter-operator reliability or interventional impact
Future Directions: Multicenter validation with larger cohorts, inter-operator reliability studies, and LUS-guided management trials to test impact on outcomes.
OBJECTIVES: The objective of this study was to investigate the validity of global lung ultrasound (LUS) scores among critically ill children with different etiologies and severities of acute respiratory failure as well as associations with outcomes. DESIGN: Prospective, observational study. SETTING: PICUs at two large children's hospitals. PATIENTS: Children receiving noninvasive or invasive mechanical ventilation and met criteria for acute respiratory distress syndrome (ARDS), lower respiratory tract infection (LRTI), or control group (no lung disease). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: LUS was performed and LUS scores calculated at two time points: 1) within 24 hours of respiratory failure for all groups (time 1) and 2) at 24 hours of time 1 for patients with ARDS and LRTI (time 2). A total of 76 patients (25 ARDS, 26 LRTI, and 25 control) were included. There was a significant difference in median time 1 global LUS scores between groups (ARDS, 19; interquartile range [IQR], 12-24; LRTI, 8 [IQR, 2-11]; and control, 2 [IQR, 0-6]; p < 0.001). Global LUS scores remained similar from time 1 to time 2 in both ARDS (19 to 17) and LRTI (8 to 7) groups. There were moderate correlations between LUS scores and oxygen saturation index (r = 0.67; p < 0.001), peripheral oxygen saturation/Fio2 ratio (r = -0.63; p < 0.001), mean airway pressure (r = 0.63; p < 0.001), positive end-expiratory pressure (r = 0.52; p < 0.001), and dynamic compliance (r = -0.43; p = 0.001). Higher LUS scores were associated with fewer ventilator-free days at 28 days (p < 0.001), fewer positive pressure ventilation-free days at 28 days (p < 0.001), and fewer ICU-free days at 28 days (p < 0.001). CONCLUSIONS: In critically ill children with acute respiratory failure, global LUS scores within 24 hours of admission differed by severity of parenchymal lung disease, correlated with oxygenation parameters, and were associated with patient-centered outcomes of duration of respiratory support and PICU length of stay.