BACKGROUND. Corticosteroids are widely used in patients with COVID 19, although their benefit-to-risk ratio remains controversial. METHODS. Patients with severe COVID-19–related acute respiratory distress syndrome (ARDS) were included from December 29, 2019 to March 16, 2020 in 5 tertiary Chinese hospitals. Cox proportional hazards and competing risks analyses were conducted to analyze the impact of corticosteroids on mortality and SARS–CoV-2 RNA clearance, respectively. We performed a propensity score (PS) matching analysis to control confounding factors. RESULTS. Of 774 eligible patients, 409 patients received corticosteroids, with a median time from hospitalization to starting corticosteroids of 1.0 day (IQR 0.0–3.0 days) . As compared with usual care, treatment with corticosteroids was associated with increased rate of myocardial (15.6% vs. 10.4%, P = 0.041) and liver injury (18.3% vs. 9.9%, P = 0.001), of shock (22.0% vs. 12.6%, P < 0.001), of need for mechanical ventilation (38.1% vs. 19.5%, P < 0.001), and increased rate of 28-day all-cause mortality (44.3% vs. 31.0%, P < 0.001). After PS matching, corticosteroid therapy was associated with 28-day mortality (adjusted HR 1.46, 95% CI 1.01–2.13, P = 0.045). High dose (>200 mg) and early initiation (≤3 days from hospitalization) of corticosteroid therapy were associated with a higher 28-day mortality rate. Corticosteroid use was also associated with a delay in SARS–CoV-2 coronavirus RNA clearance in the competing risk analysis (subhazard ratio 1.59, 95% CI 1.17–2.15, P = 0.003). CONCLUSION. Administration of corticosteroids in severe COVID-19–related ARDS is associated with increased 28-day mortality and delayed SARS–CoV-2 coronavirus RNA clearance after adjustment for time-varying confounders. FUNDING. None.

Rationale: Bronchial Dieulafoy disease (BDD), a rarely reported disease, comes from dilated or abnormal arteries under the bronchial mucosa. Patients with BDD are generally asymptomatic so this disease is frequently misdiagnosed. However, the submucosal arteries may dilate and rupture for various reasons, leading to recurrent respiratory tract bleeding and potentially life-threatening conditions. With the change of reversible factors such as intravascular pressure, the arteries may return to normal, allowing patients to recover to an asymptomatic state. This phenomenon has not been mentioned and concerned in previous studies, but it may have important implications for our correct understanding of this disease. Patient concerns: A 44-year-old female was admitted to intensive care unit with recurrent malignant arrhythmias. With the assistance of VA-extracorporeal membrane oxygenation (ECMO), both her vital signs and internal environment were all gradually stabilized. However, she had been experiencing recurrent respiratory tract bleeding. While removing the bloody secretion with a fiber bronchoscopy, a congested protruding granule on the wall of the patient’s left principal bronchus was found. Diagnosis: The patient was diagnosed with BDD and the granule was thought to be an abnormal artery of BDD. Interventions: For the patient’s condition, we did not implement any targeted interventions with the abnormal artery. Outcomes: After the weaning of VA-ECMO, the patient’s granule could not be found and the bleeding had also disappeared. She gradually weaned off the mechanical ventilation and was transferred to the Department of Cardiology. Then the patient was discharged after her condition stabilized. In more than half a year, the patient is in a normal physical condition. Lessons: The appearance and disappearance of abnormal artery is an interesting phenomena of BDD. The change of intravascular pressure due to various causes such as VA-ECMO may be the primary factor of it.

Identifying clinical predictive factors related to the prognosis of septic patients with heart failure is crucial for guiding their treatment. The present study explored prognostic factors in septic patients with heart failure using retrospective data from the Medical Information Mart for Intensive Care IV database. Among 567 septic patients with heart failure included, 166 died, and 401 exhibited survival at 28 days. Univariate analysis showed that in the 28-day mortality group, age, white blood cell count, total bilirubin, blood urea nitrogen, serum creatinine, lactate, 72-hour overall fluid balance, 72-hour total dosage of norepinephrine, and 72-hour serum potassium variability were significantly higher (all P < .05), while body mass index, pH value, and arterial partial pressure of oxygen were significantly lower (all P < .05). Binary logistic regression analysis identified age [ OR = 1.054 (1.032–1.078)], total bilirubin [ OR = 1.169 (1.016–1.346)], and 72-hour serum potassium variability [ OR = 1.617 (1.456–1.794)] as independent predictors of 28-day mortality (all P < .05). Internal validation with ROC analysis in a total of 245 patients showed that the combination of the 3 indicators yielded a higher AUROC value [0.888 (0.841–0.924)] than that of any single indicator [age: AUROC = 0.637 (0.574–0.698); total bilirubin: AUROC = 0.548 (0.484–0.612); 72-hour serum potassium variability: AUROC = 0.868 (0.819–0.908)], indicating good predictive performance. These findings suggest that 72-hour serum potassium variability, age, and total bilirubin are independent risk factors for 28-day mortality in septic patients with heart failure, and their combination significantly enhances prognostic prediction.

Objectives: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of phrenic nerve stimulation (PNS) in mechanically ventilated adult patients. Methods: PubMed, Web of Science, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) up to 21 February 2026, without language restrictions. Two reviewers independently screened studies, extracted data, and evaluated the risk of bias using the Cochrane RoB 2 tool. The certainty of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using fixed-effects or random-effects models according to heterogeneity. Results: Five RCTs involving 431 patients were included. PNS was associated with a higher weaning success rate (OR = 2.96, 95% CI: 1.04 to 8.40, p = 0.04), a shorter duration of mechanical ventilation (MD = −2.63, 95% CI: −3.90 to −1.35, p < 0.001), higher maximal inspiratory pressure (MD = 2.95, 95% CI: 1.10 to 4.79, p = 0.002), and higher diaphragm thickening fraction (MD = 15.67, 95% CI: 4.84 to 26.50, p = 0.005). No statistically significant differences were observed in ICU length of stay, rapid shallow breathing index, or tracheostomy rate. Noninvasive stimulation was generally tolerated in the included studies, whereas transvenous stimulation was associated with procedure-related serious adverse events. The certainty of evidence ranged from high to low across outcomes. Conclusions: PNS was associated with improved weaning outcomes and diaphragm function in mechanically ventilated patients. However, the evidence remains limited by the small number of RCTs, clinical heterogeneity, and uncertainty regarding long-term outcomes. Further large-scale, multicenter RCTs with standardized protocols are needed to assess the efficacy and safety of PNS.

Commentary: Neutrophil-Related Ratios Predict the 90-Day Outcome in Acute Ischemic Stroke Patients After Intravenous Thrombolysis