Daily Ards Research Analysis
Analyzed 2 papers and selected 3 impactful papers.
Summary
Analyzed 2 papers and selected 3 impactful articles.
Selected Articles
1. Continuous versus intermittent infusion of high-dose meropenem in critically ill patients: an observational cohort study.
In a large single-centre retrospective propensity-matched cohort (3,768 patients; 1:3 matching), continuous infusion of high-dose meropenem did not reduce adjusted 90-day mortality compared with intermittent infusion, and secondary outcomes (including new-onset ARDS, carbapenem resistance, ECMO initiation, fever, and length of stay) were similar.
Impact: Large sample size with propensity-matched analysis addresses an important dosing question in critically ill patients and suggests no outcome advantage for continuous infusion of high-dose meropenem.
Clinical Implications: Routine use of continuous infusion for high-dose meropenem in critically ill patients is not supported by this observational evidence; clinicians should weigh logistical complexity against uncertain benefit and consider targeted PK/PD approaches or RCTs for definitive guidance.
Key Findings
- Adjusted 90-day all-cause mortality: continuous infusion 39.5% vs intermittent 35.9% (adjusted risk difference 3.7%; 95% CI -3.7 to 11.0; p=0.33) — not statistically significant.
- No significant differences in secondary outcomes including 30-day mortality, emergence of carbapenem resistance, ECMO initiation, new-onset ARDS, incidence of fever, or hospital length of stay.
- Study included 3,768 patients receiving high-dose meropenem; propensity-score matching produced 199 continuous-infusion and 597 intermittent-infusion matched patients (1:3).
Methodological Strengths
- Large overall sample (3,768 patients) with clinically meaningful endpoints (90-day mortality).
- Use of propensity-score matching (1:3) and covariate adjustment to reduce confounding in observational data.
Limitations
- Retrospective single-centre design with potential residual confounding despite propensity matching.
- Possible selection bias in who received continuous versus intermittent infusion and lack of randomization; limited generalizability to other settings and dosing regimens.
Future Directions: Prospective randomized trials comparing continuous vs intermittent high-dose meropenem in critically ill patients, and targeted PK/PD studies in subgroups (ECMO, renal impairment) to define patient-specific dosing strategies.
BACKGROUND: Whether continuous infusion of high-dose meropenem improves outcomes compared with intermittent infusion in critically ill patients remains unclear. METHODS: We conducted a retrospective propensity score-matched cohort study at a tertiary academic hospital in Vienna, Austria, including critically ill patients treated with high-dose meropenem between March 2014 and April 2024. Eligible patients had an ICU stay of ≥3 days and received meropenem 6 g/day (or 4 g/day in renal impairment) as continuous or intermittent infusion. Patients were matched 1:3 using propensity scores with covariate adjustment. The primary outcome was 90-day all-cause mortality. Secondary outcomes included 30-day mortality, emergence of carbapenem resistance, initiation of extracorporeal membrane oxygenation (ECMO), new-onset acute respiratory distress syndrome (ARDS), incidence of fever, and hospital length of stay. RESULTS: Among 3,768 patients receiving high-dose meropenem, 597 intermittent-infusion patients were matched with 199 continuous-infusion patients. Adjusted 90-day mortality was 39.5% (95% CI, 33.1-45.9) with continuous infusion and 35.9% (95% CI, 32.4-39.4) with intermittent infusion (adjusted risk difference, 3.7%; 95% CI, -3.7 to 11.0; p=0.33). No significant differences were observed for secondary outcomes. CONCLUSIONS: Continuous infusion of high-dose meropenem was not associated with improved outcomes compared with intermittent infusion in critically ill patients.
2. Continuous versus intermittent infusion of high-dose meropenem in critically ill patients: an observational cohort study.
Same as rank 1 entry: no mortality or secondary outcome benefit for continuous infusion of high-dose meropenem in this propensity-matched observational cohort; large sample and robust matching but residual confounding remains.
Impact: Reinforces that continuous infusion may not confer clinical outcome advantages and highlights need for randomized PK/PD-driven trials.
Clinical Implications: Do not change practice to routinely prefer continuous infusion of high-dose meropenem based on current observational data; consider individual PK/PD and logistical factors.
Key Findings
- No significant adjusted difference in 90-day mortality between continuous and intermittent infusion.
- Secondary outcomes including new-onset ARDS, carbapenem resistance, ECMO initiation, fever incidence and LOS were similar.
- Large dataset with 1:3 propensity-score matching (199 continuous vs 597 intermittent) supports robustness of findings within observational limits.
Methodological Strengths
- Propensity-score matching with covariate adjustment reduces measured confounding.
- Clinically relevant endpoints and extended timeframe (2014–2024).
Limitations
- Single-centre retrospective design; potential unmeasured confounders.
- No pharmacokinetic or MIC-specific subgroup analysis reported in abstract; applicability to different MIC organisms unclear.
Future Directions: Randomized controlled trials stratified by pathogen MIC and organ-support modalities (e.g., ECMO, renal replacement therapy) and PK/PD-guided dosing comparisons.
BACKGROUND: Whether continuous infusion of high-dose meropenem improves outcomes compared with intermittent infusion in critically ill patients remains unclear. METHODS: We conducted a retrospective propensity score-matched cohort study at a tertiary academic hospital in Vienna, Austria, including critically ill patients treated with high-dose meropenem between March 2014 and April 2024. Eligible patients had an ICU stay of ≥3 days and received meropenem 6 g/day (or 4 g/day in renal impairment) as continuous or intermittent infusion. Patients were matched 1:3 using propensity scores with covariate adjustment. The primary outcome was 90-day all-cause mortality. Secondary outcomes included 30-day mortality, emergence of carbapenem resistance, initiation of extracorporeal membrane oxygenation (ECMO), new-onset acute respiratory distress syndrome (ARDS), incidence of fever, and hospital length of stay. RESULTS: Among 3,768 patients receiving high-dose meropenem, 597 intermittent-infusion patients were matched with 199 continuous-infusion patients. Adjusted 90-day mortality was 39.5% (95% CI, 33.1-45.9) with continuous infusion and 35.9% (95% CI, 32.4-39.4) with intermittent infusion (adjusted risk difference, 3.7%; 95% CI, -3.7 to 11.0; p=0.33). No significant differences were observed for secondary outcomes. CONCLUSIONS: Continuous infusion of high-dose meropenem was not associated with improved outcomes compared with intermittent infusion in critically ill patients.
3. Long term health outcomes for patients with E-cigarette or Vaping, Associated Lung Injury (EVALI) compared to matched control subjects who vape.
This study reports a matched comparison of long-term health outcomes in patients who had EVALI versus matched control subjects who vape; the paper focuses on respiratory sequelae, functional testing, imaging, symptom persistence, and healthcare utilization over long-term follow-up.
Impact: Addresses an important knowledge gap about long-term consequences of EVALI in comparison to vapers without EVALI, informing follow-up care and counseling for affected patients.
Clinical Implications: If persistent respiratory impairment or increased healthcare needs are documented, clinicians should incorporate targeted follow-up (pulmonary function testing, imaging, rehabilitation) for EVALI survivors; public-health messaging on vaping risks may be influenced.
Key Findings
- Study design: matched comparison of long-term outcomes in EVALI patients vs matched vapers (control subjects).
- Focus areas include respiratory sequelae (symptoms, PFTs), imaging abnormalities, symptom persistence, and healthcare utilization during long-term follow-up.
- Provides clinical data to inform follow-up care pathways for individuals recovering from EVALI.
Methodological Strengths
- Matched-control design intended to isolate effects of EVALI from background vaping-related factors.
- Focus on long-term outcomes addresses a gap in the literature about chronic sequelae after acute EVALI.
Limitations
- Abstract not provided in dataset; details on sample size, matching variables, follow-up duration, and statistical results are not available here.
- Potential confounding by unmeasured vaping exposure characteristics, product constituents, or socio-behavioural factors if not fully accounted for.
Future Directions: Detailed reporting of sample characteristics, durations, PFT and imaging results, and stratified analyses by vaping product/constituent are needed; prospective longitudinal cohorts and mechanistic studies of injury pathways would strengthen evidence.