Daily Ards Research Analysis

BACKGROUND: Intravenous fluid resuscitation is essential in early management of sepsis, but the optimal volume and resuscitation strategy are uncertain. This systematic review and meta-analysis aimed to synthesize the evidence comparing the efficacy and safety of restrictive versus liberal fluid resuscitation strategies in adults with sepsis or septic shock. METHODS: A systematic search of PubMed, Web of Science (WoS), Scopus, and CENTRAL was conducted from inception to November 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Randomized controlled trials (RCTs) and observational cohort studies comparing protocolized restrictive fluid strategies with liberal or standard care were included. Primary outcomes were all-cause mortality and acute kidney injury (AKI). Random-effects models were used to calculate pooled risk ratios (RRs) and mean differences (MDs), while trial sequential analysis (TSA) assessed the conclusiveness of evidence. RESULTS: Sixteen reports from 15 unique studies (nine RCTs and six observational studies) involving 5,013 patients were included. In the analysis of RCTs, restrictive fluid therapy resulted in no significant difference in all-cause mortality (RR = 0.99; 95% CI, 0.90-1.08; I CONCLUSIONS: Restrictive fluid resuscitation does not reduce overall mortality in adults with sepsis or septic shock, but it is associated with lower AKI and ARDS risk and decreased dependence on mechanical ventilation. Evidence regarding mortality is inconclusive, highlighting the need for large-scale trials to validate this finding.

INTRODUCTION: The neutrophil elastase (NE) inhibitor is a potential treatment strategy for acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). However, the clinical effectiveness of sivelestat sodium, a selective NE inhibitor, remains controversial. We performed a systematic review and meta-analysis to evaluate the effects of sivelestat in patients with ALI/ARDS. METHOD: The literature search, selection, and data extraction were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement (PRISMA) guidelines. The randomized controlled trials (RCTs) with reference lists were retrieved from Scopus, PubMed, and Cochrane Library, using the Cochrane risk-of-bias tool for the quality assessment. Logarithm relative risk (logRR), risk difference (RD), and standardized mean difference (SMD) were calculated using the fixed effects model or random effects model, depending on heterogeneity. RESULT: Ten RCTs involving 1170 patients (583 receiving sivelestat and 587 receiving standard care or placebo) were included. Sivelestat was associated with a significant reduction in 28-30-day mortality, shorter duration of mechanical ventilation, and improvement in the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO CONCLUSION: Sivelestat might be a promising adjunctive treatment for ALI/ARDS, especially in the sepsis etiology, as evidenced by reduced mortality, shortened mechanical ventilation duration, and improved oxygenation. The large-scale, well-designed RCTs are warranted.

OBJECTIVE: To implement the PIPP-ARDS protocol and evaluate its impact on the incidence and characteristics of pressure injuries, as well as its effect on nurses' perception of pressure injury prevention in patients receiving prone ventilation. DESIGN: A prospective before-after implementation study conducted following TREND guidelines and registered with the Chinese Clinical Trial Registry (ChiCTR2500101498). METHODS: Patients meeting predefined inclusion and exclusion criteria were consecutively enrolled and allocated to the pre-intervention or post-intervention period based on admission period. Patients admitted from February to July 2024 received routine nursing care (pre-intervention), whereas those admitted from August 2024 to January 2025 received the PIPP-ARDS prevention protocol (post-intervention). Data were collected on pressure injury incidence, anatomical location, and nurses' perception before and after protocol implementation. RESULTS: A total of sixty-eight patients were included in the study. The incidence of pressure injuries was significantly lower in the post-intervention period compared to pre-intervention period (20.6% vs. 44.1%, P = 0.038). Multivariable logistic regression analysis demonstrated that the intervention was independently associated with a significantly reduced risk of pressure injury (adjusted OR = 0.224, P = 0.021), whereas total prone duration was identified as an independent risk factor. The most frequently affected anatomical sites included the face (cheeks, forehead, chin, and nose), anterior chest, and anterior superior iliac spine. One hundred twenty-one intensive care nurses participated before the protocol, and ninety-four participated after implementation. Nurses exposed to the protocol showed improved perception of pressure injury prevention. Knowledge scores increased across all content domains, and nurses' attitudes toward prevention became more constructive. CONCLUSIONS: These findings reflect real-world ICU practice and provide actionable guidance for pressure injury prevention. The implementation of the PIPP-ARDS protocol was associated with a lower incidence of pressure injuries and positively correlated with improved nurses' perceptions of prevention during prone ventilation. However, given the before-after study design, further studies with larger sample sizes or randomized controlled designs are required to confirm these findings and establish causality.