Publications

OBJECTIVES: Invasive mechanical ventilation (IMV) is crucial for acute respiratory distress syndrome (ARDS) management, but mortality remains high. While spontaneous breathing is key to weaning, excessive respiratory effort may injure the lung and diaphragm. Most existing data on respiratory effort during IMV are based on brief periods of observation, potentially underestimating the burden of inappropriate efforts. This study aims to characterize the evolution of respiratory effort over time in ARDS patients and its relation to survival. We hypothesized that nonsurvivors would spend a greater proportion of time in the high-effort range during the active breathing phase compared with survivors. DESIGN, SETTING, AND PATIENTS: In this prospective cohort study, we continuously recorded airway pressure, flow, esophageal, and gastric pressures in ARDS patients on mechanical ventilation during 7 days after the onset of spontaneous breathing. We analyzed physiologic respiratory effort variables, focusing on the proportion of time spent within defined effort ranges, and compared these data between ICU survivors and nonsurvivors. Statistical analysis was conducted using variance weighted methods to account for variability in the number of respiratory cycles analyzed per patient. This study is registered at ClinicalTrials.gov under identifier NCT06490523. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 1,485,405 respiratory cycles were analyzed from 26 ARDS patients (19 survivors, seven nonsurvivors). Nonsurvivors spent significantly more time in high effort (12% vs. 3%; p = 0.006). In contrast, survivors spent more time in the moderate-effort range (50% vs. 5%; p < 0.001). The time spend with high dynamic transpulmonary driving pressure (> 25 cm H2O) was also significantly different between groups (32% survivors vs. 74% nonsurvivors; p = 0.001). CONCLUSIONS: Patients who die of ARDS are more likely to be exposed to high respiratory effort for prolonged periods of time compared with survivors.

JTD Keywords: Acute respiratory distress syndrome, Adult patients, Epidemiology, Esophageal, Esophageal pressure, Evolution, Lung injury, Mechanical ventilation, Mortality, Pressure support ventilation, Pulmonary, Respiratory effort, Transpulmonary pressure

Acute respiratory distress syndrome (ARDS) is a severe pulmonary condition that often requires mechanical ventilation (MV) to ensure adequate gas exchange and minimize ventilator-induced lung injury. This study compares statistical descriptors derived from respiratory time series with nonlinear variability metrics obtained from Poincar & eacute; plots to predict the outcomes of the weaning process in mechanically ventilated patients. The database, which includes respiratory flow recordings from 243 patients who underwent a standardized 30-minute spontaneous breathing test (SBT), was used to validate the classification models. Patients were categorized into three clinical outcome groups: successful weaning (n = 132), failed weaning (n = 88), and reintubation within 48 hours after completion of the trial (n = 23). Features were selected using nonparametric statistical tests and correlation analysis, eliminating redundancy and retaining discriminative variables. Two machine learning (ML) classifiers, random forest and feedforward neural network, were designed to identify patients belonging to each of the three clinical outcome groups. Model performance was assessed using stratified hold-out cross-validation repeated over 150 iterations, with hyperparameters optimized using Bayesian methods. The random forest classifier using Poincar & eacute; descriptors achieved a mean accuracy of 90.4% and higher F1-scores across all groups, including those who required reintubation. These findings suggest that Poincar & eacute;-based variability metrics, in combination with ensemble learning, may enhance the accurate prediction of MV weaning outcomes in ARDS patients.

JTD Keywords: Heart-rate-variability, Mechanical ventilation,weaning,acute respiratory distress syndrome,poincar & eacute, Plot, Plot,mechanical ventilation,weaning,acute respiratory distress syndrome,poincar & eacute, Successful extubation

Introduction: Application of lipopolysaccharide (LPS) is a widely employed model to mimic acute respiratory distress syndrome (ARDS). Available data regarding LPS-induced biomechanical changes on pulmonary epithelial cells are limited only to P. aeruginosa LPS. Considering that LPS from different bacteria could promote a specific mechanical response in epithelial cells, we aim to assess the effect of E. coli LPS, widely employed as a model of ARDS, in the biomechanics of alveolar epithelial cells. Methods: Young’s modulus (E) of alveolar epithelial cells (A549) was measured by atomic force microscopy every 5 min throughout 60 min of experiment after treatment with LPS from E. coli (100 μg/mL). The percentage of cells presenting actin stress fibers (F-actin staining) was also evaluated. Control cells were treated with culture medium and the values obtained were compared with LPS-treated cells for each time-point. Results: Application of LPS induced significant increase in E after 20 min (77%) till 60 min (104%) in comparison to controls. Increase in lung epithelial cell stiffness induced by LPS was associated with a higher number of cells presenting cytoskeletal remodeling. Conclusions: The observed effects of E. coli LPS on alveolar epithelial cells suggest that this widely-used LPS is able to promote a quick formation of actin stress fibers and stiffening cells, thereby facilitating the disruption of the pulmonary epithelial barrier.

JTD Keywords: Acute respiratory distress syndrome model, Alveolar epithelium, Biomechanics, E. coli, Lipopolysaccharide