Daily Ards Research Analysis

BACKGROUND: Patient-ventilator asynchrony (PVA) is common during invasive mechanical ventilation in children and may increase respiratory workload and discomfort. The IntelliSync+ (IS+) algorithm provides closed-loop synchronization by continuously analyzing airway pressure and flow waveforms to optimize inspiratory and expiratory cycling in real time. This study evaluated the efficacy and safety of IS+ compared with conventional physician-tailored synchronization in spontaneously breathing pediatric patients. METHODS: Multicenter, prospective, randomized controlled, single-blind crossover trial conducted in four pediatric intensive care units between March 2024 and May 2025. Patients aged 1 month to 18 years undergoing invasive mechanical ventilation were randomized to begin with either IS+ or conventional synchronization. Each mode was applied for 90 min (30-min run-in and 60-min measurement), separated by a 30-min washout period. The primary outcome was the Asynchrony Index (AI). Secondary outcomes included major and minor asynchrony indices, Comfort-B scores, end-tidal carbon dioxide (EtCO FINDINGS: Twenty-five patients completed both study phases. Compared with conventional synchronization, IS+ significantly reduced the overall AI (median 5.1% [IQR 4.2-6.4] vs. 12.4% [IQR 9.9-15.6]; CONCLUSION: Closed-loop synchronization with IS+ significantly improved patient-ventilator interaction without compromising comfort, oxygenation, or safety. These results support closed-loop synchronization as a feasible and physiologically sound strategy for improving ventilatory support quality in pediatric invasive mechanical ventilation. CLINICAL TRIAL REGISTRATION: [ClinicalTrials.gov], identifier [NCT05731024].

BACKGROUND AND AIMS: Pediatric acute respiratory distress syndrome (PARDS) carries high mortality in pediatric intensive care units (PICUs). The clinical benefit of early high-frequency oscillatory ventilation (HFOV) for moderate-to-severe PARDS remains controversial. This study aimed to compare clinical outcomes between HFOV and conventional mechanical ventilation (CMV) using a robust genetic matching approach. METHODS: In this retrospective case-control study, children with moderate-to-severe PARDS admitted to the two PICUs of Chongqing Medical University from January 2012 to June 2024 were analyzed in a pre-specified 7-day landmark cohort (sustained invasive MV ≥ 7 days). Genetic matching in R software was applied to balance baseline characteristics between HFOV and CMV groups. The primary outcome was 28-day mortality; secondary outcomes included ventilator-free days (VFD), PICU-free days (IFD), survival time, and survival rates stratified by pre-intubation PaO RESULTS: After matching, 53 patients were included in each group with well-balanced baseline variables. Sensitivity (Rosenbaum bounds) and robustness (nearest-neighbor matching) analyses confirmed the stability of the matched results. The 28-day mortality was significantly higher in the HFOV group than in the CMV group (49.1% vs. 28.3%, CONCLUSION: In this 7-day landmark cohort, early HFOV may not provide extra benefit in moderate-to-severe PARDS and might be associated with higher mortality, whereas CMV was linked with lower observed 28-day mortality. Further prospective studies are warranted.

BACKGROUND: Positive end-expiratory pressure (PEEP) and prone positioning are key components in the management of acute respiratory distress syndrome (ARDS), improving gas exchange and protecting the lung via enhanced lung recruitment and homogenization of lung aeration. However, higher intrathoracic pressures may increase intracranial pressure (ICP) or impair cerebral autoregulation, as reflected by vascular reactivity. This study investigated whether stepwise PEEP elevations affect ICP, the pressure reactivity index (PRx), and brain tissue oxygenation (PbO2) in a porcine ARDS model, comparing prone and supine positions, and whether baseline physiological variables modify the ICP response. METHODS: Twelve anesthetized pigs with bronchial lavage-induced ARDS were studied in a randomized crossover design with stepwise PEEP increases (5, 10, 15, and 20 cmH2O) in prone and supine positions while maintaining stable arterial carbon dioxide tension and cerebral perfusion pressure. Intracranial pressure, PRx, and PbO2 were continuously monitored, and effects of PEEP and position were analyzed using linear mixed-effects models and analysis of variance. RESULTS: Increasing PEEP was associated with a progressive rise in ICP, whereas PRx remained unchanged across PEEP levels and body positions. PbO2 showed a non-significant upward trend with increasing PEEP, while the PbO2/PaO2 ratio remained stable. Higher baseline pulmonary artery pressure was associated with larger ICP increases, whereas higher baseline respiratory rate was associated with attenuated responses. CONCLUSION: In this porcine ARDS model, moderate PEEP escalation resulted in a modest increase in ICP without impairment of cerebrovascular reactivity, with similar effects in prone and supine positions, suggesting that lung protective ventilation strategies may be compatible with stable intracranial physiology when arterial carbon dioxide tension and cerebral perfusion pressure are controlled.