I've been working on a Node+TypeScript web app on and off for the last couple years, and one thing that's always bugged me with it is database access - it uses Knex.js as a query builder. Knex is a solid (if imperfect) DSL for interacting with SQL, but as time goes on and I get more comfortable with SQL, I've started wishing I could write raw SQL instead more easily. I think an architecture like PugSQL might help bridge the gap between "passing a bunch of SQL strings around" and a query builder.
Slightly off topic further thinking - one problem I've always had with Knex and TypeScript, though, is the lack of static typing - I've been writing runtime validations for each individual query result. This has been a bit annoying to maintain at scale since I don't have very good patterns for it. With a system like PugSQL, though, I could imagine just having input and output validators for each parameterized query.
Of course, the long term dream would be to generate type definitions from the SQL files, but I assume that would require a heck of a lot of magic (e.g. "actually run a query, figure out what the schema of the result table is, and create a snapshot of that"). I haven't seen a lot of prior art in terms of "static typing of DB access without a big ol' ORM," but I'm hopeful there's some options.