Daily Ards Research Analysis

BACKGROUND AND OBJECTIVE: To identify the longitudinal subphenotypes (LSPs) in patients with acute respiratory distress syndrome (ARDS) and their transitions, and to evaluate their potential for prognostic prediction and guiding interventions. METHODS: This retrospective multicohort study derived its cohort from Zhongshan Hospital, Fudan University, China. Feature selection was performed using univariate analysis, recursive feature elimination, and correlation analysis, followed by longitudinal latent profile analysis. Cox regression model was used to compare differences in mortality and responses to interventions. A predictive model was developed through selection from nine candidate machine learning algorithms followed by grid search optimization and subsequently applied to an independent validation cohort. RESULTS: Nine hundred ninety seven patients were included in the derivation dataset. Utilizing the 20 most prognostically relevant variables, three distinct LSPs were identified. Based on Day 1, the LSPs accounted for 36.41%, 36.71%, and 26.88%, respectively. LSP 1 (HR 5.119; 95% CI: 3.657-7.165) and LSP 2 (HR 2.922; 95% CI: 2.063-4.139) were associated with higher mortality. Both high-dose corticosteroids and invasive mechanical ventilation failed to elicit a treatment response in LSP 2 and LSP 3. Conversely, prone positioning proved to be an effective intervention for LSP 2. An early shift from LSP 1 to LSP 2 was associated with increased mortality (HR 1.679; 95% CI: 1.051-2.683). Furthermore, the optimized random forest model demonstrated superior performance in differentiating the three LSPs and could identify consistent subphenotypes in validation cohort. CONCLUSIONS: Our findings underscore the importance of incorporating temporal subphenotype evolution into prognostic stratification and personalized treatment.

BACKGROUND: The factors influencing the long-term pulmonary function recovery in survivors of acute respiratory distress syndrome (ARDS) remain unclear. METHODS: We systematically searched PubMed, Embase, Cochrane Library, CNKI, and Wanfang databases for cohort studies published from inception to August 31, 2025. Two researchers independently performed literature screening and data extraction, and the Newcastle-Ottawa Scale was used to assess study quality. RESULTS: A total of 23 cohort studies involving 5876 patients were included. The meta-analysis revealed that factors associated with poor long-term pulmonary function recovery included: age ≥ 65 years (OR=2.35, 95% CI: 1.98-2.79, P < 0.001), severe ARDS (OR=3.16, 95% CI: 2.64-3.78, P < 0.001), prolonged mechanical ventilation time (OR=1.08 per additional day, 95% CI: 1.05-1.11, P < 0.001), coexisting chronic obstructive pulmonary disease (OR=3.27, 95% CI: 2.45-4.37, P < 0.001), and elevated interleukin-6 levels during the acute phase (SMD=1.24, 95% CI: 0.87-1.61, P < 0.001). The meta-analysis results showed that factors associated with favorable long-term pulmonary function recovery included: early lung-protective ventilation (OR=0.42, 95% CI: 0.33-0.54, P < 0.001), glucocorticoid intervention (OR=0.56, 95% CI: 0.43-0.73, P < 0.001), and initiation of rehabilitation treatment within ≤ 7 days of onset (OR=0.38, 95% CI: 0.29-0.49, P < 0.001). Subgroup analysis of ARDS type indicated that both disease severity and duration of mechanical ventilation influenced prognosis. CONCLUSION: Older age, severity of ARDS, prolonged ventilation time, coexisting chronic obstructive pulmonary disease and elevated interleukin-6 levels during the acute phase are the main factors associated with poor long-term pulmonary function recovery in patients with ARDS. Early lung-protective ventilation, glucocorticoid use, and rehabilitation interventions are important protective measures.

BACKGROUND: Nursing interventions play a key role in managing acute respiratory distress syndrome (ARDS), but their relationship with the dynamic physiological changes that occur during treatment is not well described. METHODS: In a retrospective cohort of 1,716 ARDS patients from the West China Hospital Big Data Platform (2012-2025), four nursing interventions, airway suctioning, oral care, prone positioning, and early enteral nutrition were examined. Trajectories of SpO₂, C-reactive protein (CRP), lactate, and creatinine were derived using latent-class mixed-effects models. Associations between interventions and trajectory membership were assessed through multinomial logistic regression. RESULTS: Three distinct trajectories were identified for each biomarker including oxygenation, inflammation, metabolism, and renal function. Early prone positioning initiated within 24 h was associated with lower odds of unfavorable oxygenation trajectories (SpO₂ trajectory 2: OR 0.08, 95% CI 0.01-0.59) and high-CRP trajectories (OR 0.18, 95% CI 0.04-0.86). Delayed prone positioning (>72 h) was associated with higher odds of both the stable-low lactate trajectory (trajectory 2: OR 5.17, 95% CI 1.21-22.06) and the U-shaped lactate trajectory (trajectory 3: OR 5.07, 95% CI 1.09-23.57). EEN was consistently linked to reduced odds of high-CRP trajectories (OR 0.31-0.45 across models). Airway suctioning was linked to more favorable oxygenation trajectories, while oral care was more common among patients with unstable oxygenation. Patients in unstable oxygenation trajectories had higher 28-day mortality, while the stable lactate trajectory showed a protective association. CONCLUSION: Distinct physiological trajectories characterize the early course of ARDS. Early and standardized nursing interventions, particularly prone positioning and enteral nutrition, were associated with more favorable recovery profiles.