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Introduction: Post-tracheostomy tracheal stenosis is a clinically relevant late complication of tracheostomy. To date, there is no standardized treatment strategy for post-tracheostomy tracheal stenosis. Contact cryoablation is one of the applicable methods. The aim of the present study was to explore the efficacy and safety of contact cryoablation for the treatment of post-tracheostomy tracheal stenosis.

Methods: A total of 63 consecutive patients were included in this unicentre, combined retrospective and prospective observational study in an intensive care unit of a German neurological specialist hospital from 30 April 2020 to 21 March 2024. Post-tracheostomy tracheal stenoses were confirmed by tracheoscopy. All eligible patients were primarily treated with contact cryoablation. Primary endpoint was the rate of successful removal of the tracheostomy tube (decannulation) until hospital discharge. Technical success was defined as the absence of an endoscopically relevant residual post-tracheostomy tracheal stenosis, and clinical success was defined as the absence of symptoms, e.g., dyspnoea and stridor, both at discretion of the endoscopist and treating physician.

Results: A total of 78 interventions were performed (median: 1 per patient). Cryoablation was applied in 67% of patients at least once. A total of 70% of patients could be decannulated after treatment. Technical success and clinical success were achieved in 88% and 70% of patients, and in only 5% of patients surgical treatment was performed. No complications were observed.

Conclusion: Contact cryoablation appears to be an effective, complication-free, simple, and non-surgical treatment option for patients with post-tracheostomy tracheal stenosis. It could be an excellent option for every patient with suitable stenosis morphology. However, other endoscopic modalities must be available or complementarily used for non-suitable stenosis morphologies.

Introduction: Balloon pulmonary angioplasty (BPA) is an effective intervention for patients with chronic thromboembolic pulmonary disease (CTEPD). We aimed to identify the patient group with a low success rate or high complication rate of BPA, which is still unclear.

Methods: Both CTEPD patients with or without pulmonary hypertension (CTEPH and NoPH-CTEPD) were included. CTEPH patients were divided into groups with or without pulmonary endarterectomy (PEA-CTEPH and NoPEA-CTEPH). The efficacy and safety of BPA were compared among the groups.

Results: There were 450, 66, and 41 sessions in the NoPEA-CTEPH, PEA-CTEPH, and NoPH-CTEPD groups, respectively. The success rate (≥1 degree improvement in flow grade) in the PEA-CTEPH group was 94.5%, significantly lower than that in the NoPEA-CTEPH (97.1%) and NoPH-CTEPD (98.4%) groups (p = 0.014). The percentage of complete flow recovery in treated vessels was also lower in PEA-CTEPH group. BPA-related complication rate in NoPEA-CTEPH, PEA-CTEPH, and NoPH-CTEPD patients was 6.1%, 6.0%, and 0.0%, respectively (p = 0.309). One BPA-related death occurred (solely in NoPEA-CTEPH). Mean pulmonary artery pressure ≥41.5 mm Hg was a predictor of BPA-related complications. NoPEA-CTEPH patients had more improvement in 6-min walk distance (6MWD, 87 ± 93 m NoPEA-CTEPH vs. 40 ± 43 m PEA-CTEPH vs. 18 ± 20 m NoPH-CTEPD, p = 0.012).

Conclusions: BPA was safe and effective for all CTEPD groups with less improvement for the PEA-CTEPH and NoPH-CTEPD groups. The success rate of BPA was lower in the PEA-CTEPH group and the complication rate was lower in the NoPH-CTEPD group. Pre-BPA treatment to lower pulmonary artery pressure should not be overlooked in CTEPD patients.

Introduction: Hematological conditions, mainly allogeneic hematopoietic cell transplantation (allo-HCT) and chronic lymphocytic leukemia (CLL), have known associations with bronchiectasis. However, data on these unique clinical entities remain limited. We aimed to evaluate the clinical characteristics and outcomes of patients with hematology-related bronchiectasis.

Methods: This retrospective study included patients with bronchiectasis following allo-HCT and CLL. Groups were matched and compared to a control group of bronchiectasis from non-hematological conditions (n = 126). Clinical variables, radiologic features, and disease outcomes were analyzed.

Results: Overall, 42 patients with bronchiectasis after allo-HCT (median age 59, 36% female) and 63 patients with bronchiectasis and CLL (median age 72, 40% female) were included. Both groups exhibited worse lung functions compared to the control. They had more isolations of Pseudomonas aeruginosa (PA) compared to the control group (21-31% vs. 9%) and less non-tuberculosis mycobacteria (3-5% vs. 21%). Allo-HCT and CLL patients also showed high rates of diffuse bronchiectasis distribution (38% and 40%), hypogammaglobulinemia (41% and 71%), and 1-year respiratory hospitalizations (50% and 54%). Only 26% of allo-HCT and 35% of CLL patients saw a pulmonologist, and only 14% performed routine airway clearance. Mortality was higher in both groups compared to controls. The key variables associated with mortality were bronchiolitis obliterans syndrome in the allo-HCT group (HR 11.1, 95% CI: 2.9-30.6) and PA isolation in the CLL group (HR 2.96, 95% CI: 1.3-6.8).

Conclusion: Hematology-related BE have distinct clinical and radiologic features with associated morbidity. These findings could help identify at-risk subgroups for early pulmonologist referral.

Introduction: Idiopathic pulmonary fibrosis (IPF) is a chronic progressive disease that subverts the normal structure of the lungs and finally causes respiratory failure. High-flow nasal therapy (HFNT) is currently used in the acute setting for IPF with acute respiratory failure. Also, acute exacerbation of IPF and end-stage disease are common indications. Chronic cough is often an unmet need in IPF because it is partially responsive to common pharmacological treatment. Moreover, opioids have known adverse events. The aim of this paper was to investigate the effects and safety of chronic HFNT on lung function and symptoms of IPF.

Methods: This is a single-center case-control study including patients affected by IPF. We included 35 adult patients with a consistent radiological diagnosis of IPF, clinical history of lung function decline, and high prevalence of symptoms. All patients received the standard of treatment, particularly including antifibrotic drugs and conventional oxygen therapy (COT). Eighteen subjects were assigned to additional treatment with HFNT for 12 months.

Results: No significant differences were observed after the follow-up with HFNT in terms of lung function. The mean forced vital capacity (FVC) was 1.89 ± 0.73 L with HFNT and 2.43 ± 0.87 L without HFNT (p = 0.09). The mean FVC decline per year was 190 mL with HFNT versus 200 mL with standard of care. The mean DLCO % of predicted was 28.86 ± 14.51% with HFNT and 36.03 ± 19.18% with COT (p = 0.276). No significant impact was observed on dyspnea; the mean Borg scale value was 6.72 ± 2.22 after HFNT and 7.14 with COT (p = 0.56). The score for cough significantly improved after treatment with a mean score in the HFNT group being 46.67 ± 10.85 versus 73.8 ± 18.43 (p < 0.0001) with standard of care.

Conclusions: Long-term HFNT significantly reduces chronic cough in patients affected by IPF compared to COT. Lung function including FVC and DLCO is not significatively influenced.

Introduction: Pulmonary exacerbations increase the requirement of aminoglycoside (AG) antibiotics in people with cystic fibrosis (pwCF). Several studies have shown that AGs have a cumulative effect on ototoxicity. We aimed to investigate the relationship between AG exposure and ototoxicity by using 3 different methods in patients with CF.

Materials/methods: The multicenter study included 121 pwCF aged between 5 and 18 years with a history of parenteral AG exposure. Standard pure-tone audiometry, extended high-frequency pure-tone audiometry (EHF-PTA), and distortion-product otoacoustic emissions (DPOAE) tests were performed. Mitochondrial mutation analysis for m1555G>A was performed in 61 patients.

Results: Median age was 12.85 years and 52.1% (n = 63) were male. 18.2% (n = 22) of the patients had received parenteral AGs more than 5 courses/lifetime. Ototoxicity was detected in at least one of the tests in 56.2% (n = 68) of the patients. Only 10.7% (n = 13) of the patients had reported a symptom indicating ototoxicity. 30.3% (n = 30) of the patients had ototoxicity in the low exposure group, while it was 45.5% (n = 10) in the high exposure group according to EHF-PTA (p > 0.05). Median number of parenteral amikacin courses was significantly higher in the ototoxic group (2 [1.25-5.75] vs. 2 [1-3]; p = 0.045). No m1555A>G mutation was detected in 61 patients who screened for mitochondrial mutation analysis.

Conclusion: As AG ototoxicity occurs primarily at high frequencies, EHF-PTA is important in early detecting ototoxicity. EHF-PTA and DPOAE detected ototoxicity in some patients with normal PTA results. All pwCF with a history of AG exposure should be evaluated for hearing loss since symptoms may only be noticed in the late period.

Introduction: This study aimed to evaluate both the clinical efficacy and safety of airway stent placement in the treatment of patients with esophageal cancer-associated airway esophageal fistula (AEF). The focus is on evaluating improvements in patient survival and quality of life.

Methods: Overall, this study enrolled 111 patients diagnosed with esophageal cancer-associated AEF. Among them, 50 (45.0%) and 61 (55.0%) patients received airway stent placement and conservative treatment, respectively. Follow-up assessments were conducted to determine the clinical efficacy and safety of the interventions, with survival and quality of life as the primary endpoints.

Results: By the end of the follow-up, 98 of 111 patients (88.3%) had died, leaving 13 survivors (11.7%). Patients with esophageal cancer-associated AEF had an overall mean survival time of 147.4 (95% CI, 123.9-170.9) days. Patients in the stent placement group had a mean survival of 192.5 (95% CI, 151.2-233.7) days, which was significantly longer than the 110.0 (95% CI, 88.1-131.8) days in the conservative treatment group (p < 0.001). Sex (p = 0.017), tumor stage (p = 0.030), surgery (p = 0.005), pulmonary infection (p < 0.001), fistula size (p < 0.001), and pre-Karnofsky Performance Status (KPS) (p < 0.001) were the independent risk factors affecting survival. Furthermore, patients in the stent placement group demonstrated improved KPS scores post-treatment, increasing from 48.2 to 57.9 (p = 0.017).

Conclusion: Airway stent placement is beneficial in alleviating the symptoms, quality of life, and survival of patients with esophageal cancer-associated AEF.

Introduction: Rapid On-Site Evaluation (ROSE) entails immediate pathological evaluation of diagnostic specimens in the procedure room, facilitating real-time feedback to operator on specimen adequacy and diagnosis. There is ongoing debate about its role in the field of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration.

Methods: To re-evaluate the impact of ROSE, we completed a retrospective cohort analysis of prospectively maintained Greater Manchester EBUS database encompassing all linear EBUS procedures between 1 January 2017 and 31 December 2018 at the ROSE centre versus all linear EBUS procedures in the same period at a non-ROSE centre. Diagnostic performance plus procedural factors such as lymph node (LN) stations sampled and sedation doses were examined and then stratified according to EBUS indication.

Results: In total, 1,650 consecutive EBUS procedures were examined across two centres. Using ROSE resulted in statistically significant reduction in number of nodes sampled, time to pathology, and sedation doses for most indications. In 697 staging EBUS, sensitivity at the ROSE centre was 95% (95% CI 91-97%), negative predictive value (NPV) 93% (95% CI 88-96%) with prevalence of mediastinal nodal metastases of 27% (103/376) versus non-ROSE sensitivity 85% (95% CI 79-90%), NPV 86% (95% CI 80-90%) with prevalence of mediastinal nodal metastases of 32% (103/321). In 329 diagnostic EBUS, using ROSE resulted in a statistically significant reduction in number of LN stations sampled per procedure (median 1 station [1-1] with ROSE vs. 2 [1-2], p < 0.001). Diagnostic performance was higher at the ROSE centre including increases in sensitivity of 7% for diagnostic EBUS in advanced lung cancer, 20% for isolated mediastinal/hilar lymphadenopathy, and 17% for diagnosis of nodal metastases from extra-thoracic malignancy.

Conclusion: This study suggests ROSE may provide additional value in diagnostic performance in EBUS and warrants further discussion in an evolving lung cancer and bronchoscopic landscape.

Introduction: People with post-COVID-19 condition (PCC) suffer from a wide range of symptoms, including anxiety. Studies have already shown that cranial electrotherapy stimulation (CES) has a positive effect on anxiety in anxious people. This randomised, controlled, double-blind, single-centre pilot study aimed to investigate the effects of CES as an adjunctive therapy during rehabilitation on anxiety symptoms in people with PCC.

Methods: Adults with PCC were randomised to an intervention group with rehabilitation and CES (100 μA) or a control group with rehabilitation and sham stimulation. CES was applied via electrodes to the earlobes for 60 min daily for 3 weeks. The Beck Anxiety Inventory (BAI) score was collected at baseline and at discharge.

Results: Forty people with PCC completed the trial. We found that both groups with (n = 20) and without CES (n = 20) improved significantly in terms of change in the BAI score (CES_group: p = 0.037; sham_group: p = 0.018), with no difference between groups (p = 0.82). In a subgroup analysis of anxious patients only (BAI: ≥16 points, baseline score), both groups (CES_anxious: n = 10, sham_anxious: n = 10) significantly improved the BAI score (CES_anxious: p = 0.008; sham_anxious: p = 0.002) with no difference between groups (p = 0.69).

Conclusion: This study suggests that CES had no additional benefit on anxiety symptoms during rehabilitation in people with PCC.