Precision PEEP Titration,Neuromodulation Limits,and Metabolic Pain Pathways

This single-center randomized controlled trial evaluated an electrical impedance tomography (EIT)-guided individualized ventilation strategy (n = 42) versus a standard lower-PEEP/FiO2 strategy (n = 40) in adults with moderate-to-severe trauma- or postoperative-associated ARDS. The EIT protocol involved recruitment maneuvers and decremental PEEP titration to identify the optimal PEEP at the intersection of regional collapse and overdistension curves.

Over 3 days, the EIT group demonstrated significantly greater improvements in the co-primary physiological outcome of PaO2/FiO2 (Sidak-adjusted p < 0.05) without experiencing increases in plateau pressure or driving pressure. Static respiratory system compliance (Cstat) trajectories and secondary clinical outcomes, including ventilator-free days and 28-day mortality, were similar between groups.

The double-blind, sham-controlled MODEST randomized clinical trial investigated whether transcranial electrical stimulation (tES) in the postanesthesia care unit (PACU) could modulate postoperative delirium (POD) incidence in patients aged 65 or older undergoing elective surgery. Participants were randomized to receive alpha-transcranial alternating current stimulation (tACS) of the salience network (n = 68), transcranial direct current stimulation (tDCS) of the frontoparietal network (n = 83), or sham stimulation (n = 74).

There were no significant differences in POD incidence in the ward between the groups (tACS: 11.5%, tDCS: 14.3%, sham: 9.2%; p > 0.05). Similarly, no differences were found in PACU delirium, delirium severity, or pain levels. A prespecified subgroup analysis suggested that tACS might reduce POD incidence in patients undergoing longer surgeries (3 to 5 hours).

This Cochrane systematic review evaluated the efficacy and safety of methylxanthines (such as caffeine or aminophylline) compared to placebo or no treatment for preventing or treating intermittent hypoxemia or respiratory insufficiency in late preterm infants (34 to 36 weeks of gestation).

The review highlights the physiological role of methylxanthines as adenosine receptor antagonists that stimulate the respiratory center, increase minute ventilation, and improve diaphragmatic contractility. However, the authors note a critical lack of high-quality randomized controlled trials specifically targeting this late preterm cohort, leaving clinical practice heavily reliant on extrapolation from extremely preterm infants.