Nursing interventions and multidomain physiological trajectories in ARDS: a retrospective cohort study

Area of Science:

• Critical Care Medicine
• Nursing Science
• Pulmonary Medicine

Background:

• Acute Respiratory Distress Syndrome (ARDS) management relies heavily on nursing interventions.
• The dynamic physiological changes during ARDS treatment and their relation to nursing care are not fully understood.

Purpose of the Study:

• To investigate the association between specific nursing interventions and physiological recovery trajectories in ARDS patients.
• To identify how interventions like airway suctioning, oral care, prone positioning, and early enteral nutrition impact biomarkers of oxygenation, inflammation, metabolism, and renal function.

Main Methods:

• Retrospective cohort study of 1,716 ARDS patients.
• Latent-class mixed-effects models used to derive physiological trajectories (SpO₂, CRP, lactate, creatinine).
• Multinomial logistic regression assessed the association between nursing interventions and trajectory membership.

Main Results:

• Three distinct physiological trajectories were identified for each biomarker.
• Early prone positioning (<24h) linked to better oxygenation and lower C-reactive protein (CRP) levels.
• Early enteral nutrition (EEN) associated with reduced odds of high-CRP trajectories; airway suctioning linked to favorable oxygenation.

Conclusions:

• Distinct physiological trajectories characterize early ARDS.
• Early and standardized nursing interventions, especially prone positioning and EEN, are associated with improved patient recovery profiles.
• These findings highlight the critical role of timely nursing interventions in optimizing ARDS patient outcomes.