Daily Ards Research Analysis
Analyzed 2 papers and selected 2 impactful papers.
Summary
Today’s papers address critical care pharmacotherapy and vaping-related lung injury. A large propensity score-matched cohort found no outcome advantage of continuous high-dose meropenem over intermittent infusion, including no difference in new-onset ARDS. Another study focuses on long-term health outcomes after EVALI compared with matched vaping controls, highlighting the need for longitudinal surveillance after acute lung injury.
Research Themes
- Antibiotic dosing strategies in critical illness
- Risk of new-onset ARDS in ICU populations
- Long-term outcomes after vaping-associated lung injury (EVALI)
Selected Articles
1. Continuous versus intermittent infusion of high-dose meropenem in critically ill patients: an observational cohort study.
In a single-center, propensity score-matched cohort of ICU patients receiving high-dose meropenem, continuous infusion did not reduce 90-day mortality compared to intermittent infusion. Secondary outcomes, including new-onset ARDS, carbapenem resistance, ECMO initiation, fever incidence, and length of stay, were also similar.
Impact: This study addresses a common pharmacodynamic question in critical care and provides negative evidence against routine continuous infusion at high doses. It informs stewardship and dosing protocols where ARDS risk and mortality are key outcomes.
Clinical Implications: Routine continuous infusion of high-dose meropenem should not be assumed superior to intermittent dosing for mortality or ARDS prevention in critically ill patients; dosing strategies can prioritize feasibility and therapeutic drug monitoring where available.
Key Findings
- After 1:3 propensity score matching (199 continuous vs 597 intermittent), adjusted 90-day mortality did not differ (39.5% vs 35.9%; risk difference 3.7%; 95% CI -3.7 to 11.0; p=0.33).
- Secondary outcomes showed no significant differences, including 30-day mortality, emergence of carbapenem resistance, ECMO initiation, new-onset ARDS, fever incidence, and hospital length of stay.
- Eligible ICU patients received 6 g/day meropenem (or 4 g/day with renal impairment) via continuous or intermittent infusion over a 10-year period at a tertiary academic center.
Methodological Strengths
- Propensity score matching with covariate adjustment to reduce confounding
- Clinically meaningful primary (90-day mortality) and multiple secondary outcomes including new-onset ARDS
Limitations
- Retrospective single-center design with potential residual confounding
- Lack of therapeutic drug monitoring and pharmacokinetic/pharmacodynamic correlation limits mechanistic interpretation
Future Directions: Prospective randomized trials incorporating therapeutic drug monitoring and PK/PD-guided dosing are needed to define subgroups who may benefit from continuous infusion.
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. Long term health outcomes for patients with E-cigarette or Vaping, Associated Lung Injury (EVALI) compared to matched control subjects who vape.
This study compares long-term health outcomes among patients with prior EVALI to matched individuals who vape, aiming to quantify residual morbidity after acute lung injury. By leveraging a matched-control design, it seeks to isolate the impact of EVALI beyond vaping exposure alone.
Impact: By focusing on long-term outcomes and using vaping controls, this work addresses a critical knowledge gap in the prognosis of EVALI survivors and potential chronic sequelae.
Clinical Implications: Findings can inform follow-up strategies, pulmonary function testing schedules, and counseling about ongoing vaping in patients with prior EVALI.
Key Findings
- The study employs a matched-control design comparing EVALI survivors with vaping controls to assess long-term health outcomes.
- Outcomes of interest focus on persistent respiratory and systemic health effects beyond the acute episode.
- Design aims to disentangle effects of EVALI from vaping exposure by matching on key characteristics.
Methodological Strengths
- Use of matched vaping controls to isolate EVALI-specific effects
- Focus on long-term outcomes beyond hospitalization
Limitations
- Abstract not available; specific sample size, follow-up duration, and results are not detailed in the provided data
- Potential residual confounding and selection bias inherent to observational matched designs
Future Directions: Future multicenter prospective cohorts with standardized pulmonary function testing and imaging could clarify trajectories and risk factors for chronic impairment after EVALI.