Daily Ards Research Analysis

BACKGROUND: Sepsis is a life-threatening syndrome driven by dysregulated inflammation and immunity, often leading to multiple organ dysfunction. The lung is commonly affected early, and sepsis-related lung injury, including acute respiratory distress syndrome (ARDS), is associated with poor survival. Although models have been proposed to predict lung injury and short-term mortality once injury occurs, their performance, methods, and certainty of evidence remain insufficiently assessed. METHODS: We searched PubMed, Embase, and the Cochrane Library for studies published up to December 11, 2025. Risk of bias and applicability were assessed with PROBAST, and certainty of evidence was appraised using an AUC-based adaptation of GRADE. The protocol was registered in PROSPERO. The individual prediction model was the unit of analysis. We extracted AUC, sensitivity, and specificity. Pooled estimates were calculated separately for ARDS occurrence and short-term mortality in sepsis-associated lung injury, and separately for training, validation, and test phases, with no pooling across phases. RESULTS: Nine studies were included, eight of them from China. Together they reported 68 model phase units: 24 training, 21 validation, and 23 test AUCs. PROBAST classified 4 studies as having high overall risk of bias and 6 as having unclear risk; only three studies had low concern for applicability. Certainty of evidence was low for all outcome families and modeling phases. For ARDS occurrence, the pooled test-phase AUC was 0.749 (95% CI, 0.648-0.849; CONCLUSION: Current models showed moderate discrimination, but their clinical use is limited by bias, weak methods, low certainty, and heterogeneity. ARDS occurrence and mortality should be developed, validated, and reported separately. Future work needs transparent designs and external validation before implementation. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251275870, identifier CRD42025127587.

OBJECTIVE: Mechanical ventilation is a key modifiable risk factor for bronchopulmonary dysplasia (BPD) in preterm infants with respiratory distress syndrome (RDS). Minimally invasive surfactant therapy (MIST) enables surfactant delivery to spontaneously breathing infants . MIST use has been associated with lower rates of adverse outcomes including death and BPD; however, uptake in U.S. NICUs has been variable. At our level IV NICU, Intubate-Surfactant-Extubate (InSurE) was the standard method for surfactant delivery in infants on non-invasive respiratory support. We aimed to increase MIST utilization and evaluate its impact on respiratory care practices and clinical outcomes. STUDY DESIGN: A quality improvement (QI) initiative was launched with a SMART aim to increase MIST use from 3% to 80% within one year. Interventions included development of standardized guildelines, creation of procedural kits, multidisciplinary education, and identification of clinical champions. Iterative Plan-Do-Study-Act (PDSA) cycles were supported by real time audits and structured debriefings. Primary process measure was MIST utilization; secondary measures included procedural adherence, intubation within 7 days, and pharmacologic pre-medication use as a balancing measure. RESULTS: MIST use increased from 3% to 97% of eligible infants within one year, with special cause variation and sustained centerline shift on p chart analysis. Procedural adherence was high, with only minor single step deviations on audit. The rate of intubation within 7 days of surfactant administration was unchanged pre and post MIST implementation (19% vs 18%). Pharamacologic pre-medication use decreased significantly from 17% to 1% (p=0.002). At the system level, the proportion of infants recieving surfactant via intubation decreased from 71% to 37%, reflecting a shift towards noninvasive respiratory management. CONCLUSION: A structured, multidisciplinary QI approach was associated with increased and sustained use of MIST and a shift toward noninvasive surfactant delivery. This initiative demonstrates the feasibility of implementing MIST in a high acuity level IV NICU.

Sepsis-associated acute respiratory distress syndrome (ARDS) is a common clinical fatal complication, and intestinal flora imbalance has been proved to be a key link in the mechanism of morbidity. Intestinal dysbacteriosis directly contributes to lung injury through mechanisms such as microbial translocation, systemic inflammation, and immune dysregulation, and depletion of short-chain fatty acids (SCFAs) as key protective metabolites is an important driver of ARDS progression. SCFAs, mainly including acetate, propionate and butyrate, exert anti-inflammatory, immunomodulatory and barrier protective effects by inhibiting histone deacetylase (HDACs) and activating G protein-coupled receptors (GPCRs). However, SCFAs also exhibit concentration, type, and inflammation stage-dependent bidirectional regulatory properties. Clearly defining this bidirectional regulation is a critical factor for precision dosing and personalized therapies in a clinical setting. This article systematically reviews the causal mechanism of ARDS caused by intestinal flora imbalance, the bidirectional regulation of SCFAs, and the intervention strategies based on intestinal flora, providing new ideas for the precise treatment of sepsis-associated ARDS.