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

## TL;DR

This study shows that early nursing interventions like prone positioning and enteral nutrition are linked to better outcomes in ARDS patients.

## Contribution

The study identifies specific physiological trajectories and links early nursing interventions to improved recovery in ARDS.

## Key findings

- Early prone positioning is associated with better oxygenation and lower inflammation in ARDS patients.
- Delayed prone positioning correlates with less favorable metabolic trajectories.
- Early enteral nutrition reduces the risk of high inflammation in ARDS patients.

## Abstract

Nursing interventions play a key role in managing acute respiratory distress syndrome (ARDS), but their relationship with the dynamic physiological changes that occur during treatment is not well described.

In a retrospective cohort of 1,716 ARDS patients from the West China Hospital Big Data Platform (2012–2025), four nursing interventions, airway suctioning, oral care, prone positioning, and early enteral nutrition were examined. Trajectories of SpO₂, C-reactive protein (CRP), lactate, and creatinine were derived using latent-class mixed-effects models. Associations between interventions and trajectory membership were assessed through multinomial logistic regression.

Three distinct trajectories were identified for each biomarker including oxygenation, inflammation, metabolism, and renal function. Early prone positioning initiated within 24 h was associated with lower odds of unfavorable oxygenation trajectories (SpO₂ trajectory 2: OR 0.08, 95% CI 0.01–0.59) and high-CRP trajectories (OR 0.18, 95% CI 0.04–0.86). Delayed prone positioning (>72 h) was associated with higher odds of both the stable-low lactate trajectory (trajectory 2: OR 5.17, 95% CI 1.21–22.06) and the U-shaped lactate trajectory (trajectory 3: OR 5.07, 95% CI 1.09–23.57). EEN was consistently linked to reduced odds of high-CRP trajectories (OR 0.31–0.45 across models). Airway suctioning was linked to more favorable oxygenation trajectories, while oral care was more common among patients with unstable oxygenation. Patients in unstable oxygenation trajectories had higher 28-day mortality, while the stable lactate trajectory showed a protective association.

Distinct physiological trajectories characterize the early course of ARDS. Early and standardized nursing interventions, particularly prone positioning and enteral nutrition, were associated with more favorable recovery profiles.