Daily Ards Research Analysis
Analyzed 22 papers and selected 3 impactful papers.
Summary
Analyzed 22 papers and selected 3 impactful articles.
Selected Articles
1. Viscoelastic energy index and pulmonary resilience in mechanically ventilated patients: a Bayesian longitudinal multicentre study.
In a multicenter retrospective study applying Bayesian modeling, a higher viscoelastic energy index (VEI) derived from pressure–volume loops was associated with lower ICU mortality in moderate–severe ARDS. VEI tracked mechanical efficiency (higher relative resilience, reduced hysteresis) while remaining relatively tolerant in energetic components, suggesting its potential as a physiologic biomarker to guide ventilator settings.
Impact: Introduces a quantifiable, energy-based metric that links ventilator mechanics to outcomes, offering a potentially actionable target beyond conventional pressures and volumes.
Clinical Implications: VEI could inform individualized ventilator titration (e.g., respiratory rate and driving pressure) to minimize dissipated energy and improve outcomes in ARDS; prospective validation and interventional trials are warranted.
Key Findings
- Higher VEI associated with lower ICU mortality in moderate–severe ARDS (posterior probability 89.6%).
- VEI decreased with higher respiratory rate, higher driving pressure/flow, lower compliance, and reduced FRC.
- As VEI increased, relative resilience rose (0.93 to 0.97) and hysteresis decreased, indicating improved mechanical efficiency without structural overload.
Methodological Strengths
- International multicentre dataset with quantitative pressure–volume energy decomposition
- Bayesian modeling with subgroup analyses stratified by ARDS severity
Limitations
- Retrospective observational design without interventional testing of VEI-guided strategies
- Generalizability limited to volume-controlled ventilation; sample size not explicitly reported
Future Directions: Prospective multicenter validation, protocolized VEI-guided ventilation trials, and integration with bedside monitoring to evaluate causal impact on VILI and mortality.
OBJECTIVE: The cyclical energy load imposed by the mechanical ventilator can influence mechanical efficiency and may be associated with an increased risk of lung injury. This study proposes the Viscoelastic Energy Index (VEI) and relative resilience, which incorporate biophysical, mathematical and geometric principles, to analyse the association between VEI and relative resilience with ARDS severity and ICU mortality. DESIGN: International, multicentre, retrospective study; quantitative analysis of pressure-volume curves to estimate energy delivered, dissipated, and recovered per ventilatory cycle. Bayesian modelling used to assess associations and perform subgroup analyses. SETTING: 4 intensive care units across 4 Latin American countries PATIENTS: Adults who received invasive mechanical ventilation in volume-controlled mode, with (mild and moderate/severe ARDS) and without ARDS. MAIN VARIABLES OF INTEREST: VEI and relative resilience, ARDS severity, ICU mortality. RESULTS: High respiratory rate, elevated driving pressure and flow, lower compliance and reduced functional residual capacity were associated with lower VEI. In patients with moderate-severe ARDS, a higher VEI was associated with lower ICU mortality (posterior probability 89.6%). As VEI increased, dissipated energy rose marginally while relative resilience increased from 0.93 to 0.97, indicating improved initial mechanical efficiency. Hysteresis decreased progressively and the relative proportion of elastic and resistive components remained stable, suggesting energetic tolerance without structural overload. CONCLUSIONS: A higher VEI is associated with greater resilience and lower mortality in patients with ARDS. Prospective studies are needed to confirm these findings.
2. COVID-19 Mortality in Swedish Intensive Care Units: A Multicenter Survival Analysis.
Across seven Swedish ICUs, unadjusted 90-day COVID-19 mortality varied from 8.5% to 30%, and between-hospital differences persisted after adjustment with hazard ratios 2.38–5.06. Findings implicate organizational and contextual determinants of outcomes beyond case-mix and calendar time.
Impact: Quantifies substantial, adjusted hospital-level variability in ICU outcomes, prioritizing system-level quality improvement targets for pandemic critical care.
Clinical Implications: Benchmarking and audit of ICU organizational factors, staffing, and care pathways are warranted; triage and transfer policies may need revision to mitigate hospital-of-first-admission effects.
Key Findings
- Unadjusted 90-day mortality ranged from 8.5% to 30% across hospitals (p<0.001).
- After adjustment (case-mix, calendar time, county), all hospitals had higher mortality than the reference hospital (HR 2.38–5.06).
- Results suggest hospital-level organizational/contextual determinants significantly affect ICU survival in COVID-19.
Methodological Strengths
- Multicenter design with 90-day mortality endpoint and mixed-effects Cox modeling
- Adjustment for key confounders including SAPS3, comorbidities, BMI, and smoking
Limitations
- Retrospective observational design with potential residual confounding
- Limited number of hospitals (n=7); organizational drivers not directly measured
Future Directions: Prospective system-level studies measuring staffing, surge capacity, protocols, and resource allocation; interventional quality-improvement programs to reduce hospital-level mortality variation.
BACKGROUND: Mortality among critically ill COVID-19 patients has varied globally. In Sweden, geographic differences in mortality have also been observed. The current study aimed to determine whether mortality differences persist after adjusting for differences in case-mix, and to identify potential independent factors contributing to regional variations in mortality. METHODS: We conducted a multicenter cohort study including adult patients admitted to seven hospital ICUs across three Swedish healthcare counties between March 1, 2020 and July 31, 2021. These ICUs include one university hospital, three county hospitals and three local hospitals, and cover the intensive care infrastructure for approximately one million inhabitants. Patients were assigned to the hospital of initial ICU admission, even if transferred later during the course. Patient characteristics, disease severity, respiratory support, and treatments were registered. Primary outcome was 90-day mortality. A mixed-effects Cox proportional hazards model was used. RESULTS: Seven hundred and forty seven patients were included. The unadjusted 90-day mortality varied significantly, with the highest rate at 30%, and the lowest at 8.5% (p < 0.001). After adjustment for baseline confounders (Charlson comorbidity index, sex, SAPS3, age, smoking status, BMI), calendar time and healthcare county (random intercept), all hospitals were significantly associated with increased 90-day mortality compared with the lowest mortality hospital. Hazard ratios ranged from 2.38 to 5.06. CONCLUSION: Among patients admitted to ICU due to COVID-19, we observed a difference in mortality related to the hospital of first ICU admission. This difference persisted after adjustment for calendar time, baseline confounders, and healthcare county. Potential explanations are lacking within the current study. Future studies should focus on comprehensive evaluation of both organizational and contextual determinants of mortality. EDITORIAL COMMENT: This analysis from 3 Swedish counties (7 hospitals) for COVID ICU cases presents factors and relations to mortality risk, including factors for first admission to university-larger-, or smaller hospital. An association was observed for higher risk if the first ICU admission was in a smaller hospital, though recognizing that this is a dataset coming from a small set of hospitals.
3. Contemporary outcomes of flail chest injuries: An update from ACS-TQIP (2017-2023).
In a large ACS-TQIP analysis (2017–2023), flail chest outcomes improved substantially versus a 2014 benchmark. Surgical stabilization of rib fractures (SSRF) was associated with lower in-hospital mortality (3.3% vs. 9.2%) but longer ICU and hospital length of stay and more unplanned ICU admissions.
Impact: Provides contemporary, high-powered estimates of outcomes and treatment associations in flail chest, informing trauma ICU practice and resource planning.
Clinical Implications: SSRF may be considered to reduce mortality in selected patients, while anticipating longer ICU/hospital stays; advances in standardized care likely underpin improved population outcomes.
Key Findings
- Among 41,542 flail chest patients (19,170 matched), overall in-hospital mortality was 6.24%, VAP 3.66%, ARDS 2.22%.
- SSRF was associated with lower in-hospital mortality versus nonoperative care (3.3% vs. 9.2%, p<0.01) but longer LOS and more unplanned ICU admissions.
- Compared with 2014 data, mechanical ventilation, tracheostomy, and mortality rates markedly decreased, reflecting improved critical care and standardization.
Methodological Strengths
- Very large national registry with propensity-score matching
- Multivariable analyses accounting for key concomitant injuries
Limitations
- Retrospective design with potential residual confounding and selection bias for SSRF
- Longer LOS in SSRF may reflect confounding by indication and perioperative factors
Future Directions: Prospective comparative studies or pragmatic trials to define indications and timing for SSRF and to evaluate patient-centered outcomes and resource use.
BACKGROUND: Flail chest represents one of the most severe forms of blunt thoracic injury and is associated with significant morbidity and mortality. Much of the understanding of flail chest epidemiology, and outcomes came from Dehghan et al. (2014). Since then, flail chests management has undergone substantial evolution. Given these changes, we sought to examine the outcomes of flail chest that accurately reflects current clinical practice. METHODS: This is a retrospective study analyzing the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) 2017 to 2023 data on flail chest patients. Propensity-score matching was performed to compare clinical outcomes in patients SSRF versus no SSRF. Multivariable analysis was performed to compare the outcome of flail chest patients with concomitant head injury or pulmonary contusion. Our primary outcome is in-hospital mortality, with mechanical ventilation, hospital and Intensive Care Unit (ICU) length of stay (LOS), and the rate of pneumonia, sepsis, and tracheostomy. RESULTS: A total of 41,542 patients with flail chests were identified, 19,170 after matching. Overall, 29.08% required mechanical ventilation, 4.99% tracheostomy, 6.24% in-hospital mortality, 3.66% VAP incidence, and 2.22% ARDS. SSRF patients had a significantly lower rate of in-hospital mortality compared with nonoperative patients (3.3% vs. 9.2%, p<0.01). However, SSRF was associated with a longer hospital LOS (11.9 vs. 7.2 days, p<0.01), ICU LOS (8 vs. 5 days, p<0.01), and higher rate of unplanned ICU admission (7.5% vs. 4.4%, p<0.01) in flail chest patients. CONCLUSIONS: Compared with Dehghan et al. (2014), our analysis demonstrates significant improvements: mechanical ventilation rate decreased from 59% to 29.08%, tracheostomy from 21% to 4.99%, and mortality from 16% to 6.24%. These reductions in morbidity and mortality reflect a decade of optimized critical care and standardized management in flail chest trauma. (J Trauma Acute Care Surg 2026;00:000-000 Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). LEVEL OF EVIDENCE: Level III (Prognostic/ Epidemiological).