Respiration最新文献

Background: Lung transplantation (LT) remains the gold standard treatment for patients with end-stage lung disease, but persistent organ shortage challenges equitable organ allocation. While post-transplant survival has been well characterized in the U.S., data from corresponding cohorts remain limited. This study analyzed three-year survival outcomes among German LT recipients and explored a simplified donor-recipient hazard score with a particular focus on rescue allocation.

Methods: We retrospectively analyzed 999 patients who underwent LT in Germany between 2006 and 2016 using data from the German Transplant Registry. Univariate and multivariate analyses were performed to identify survival predictors. A simplified hazard score was developed using Cox regression and validated with C-index and Brier scores.

Results: Rescue allocation was applied in 42.3% of cases and was independently associated with improved survival (HR 0.64, 95% CI 0.49-0.85, p=0.002). Additional factors associated for mortality included donor smoking (HR 1.37, p=0.03), lung allocation score (LAS) >55 (HR 1.85, p<0.001), total lung capacity ratio ≤0.86 (HR 1.45, p=0.03), and donor age >55 (HR 1.24, p=0.11). A simplified hazard score was derived from these variables, with absence of rescue allocation contributing one point. Three-year survival declined to 56% (95% CI 49-64%) when more than two risk factors were present.

Conclusion: This study identifies key donor and recipient factors associated with three-year survival after lung transplantation in Germany. Rescue allocation was frequently applied and unexpectedly associated with improved survival outcomes in this cohort. The hazard score, showing moderate discrimination (C-index = 0.62), should be regarded as an exploratory clinical decision-support tool requiring external validation. These findings highlight the complexity of organ allocation under the current LAS system and underscore the need for ongoing evaluation of LAS policies in settings of organ shortage.

Introduction: Shape-sensing robotic-assisted bronchoscopy (ssRAB) is a novel technique for the diagnosis of peripheral pulmonary lesions (PPLs). There are no prior studies who have assessed the learning curve using learning curve cumulative summation (LC-CUSUM) and cumulative summation (CUSUM) analyses with diagnostic yield (DY) as the main endpoint.

Methods: We performed a single-center analysis of the learning curve of ssRAB combined with cone beam computed tomography (CBCT) procedures for the diagnosis of PPL performed by two bronchoscopists experienced with 3D imaging-guided bronchoscopy techniques using (1) an LC-CUSUM followed by CUSUM analysis, (2) a CUSUM analysis, with strict DY as endpoint. We will compare these methods.

Results: A total of 131 patients with a median lesion size of 12 mm (9-18 mm) were navigated by two bronchoscopists. In the first method, the LC-CUSUM analysis indicated that both bronchoscopists were statistically declared proficient after 43 and 42 procedures, with subsequent CUSUM analysis confirming sustained performance thereafter. In the second method, CUSUM analysis revealed that both bronchoscopists were deemed in control during all procedures.

Conclusion: The CBCT-enhanced ssRAB performance of bronchoscopists experienced with CBCT-guided navigation bronchoscopy was in control from the start. LC-CUSUM and CUSUM are useful tools for assessing the learning curve and procedural performance. While CUSUM indicated that performance of the experienced bronchoscopists were in control from the start, LC-CUSUM inherently assumes initial non-proficiency leading to a larger number of procedures required to establish proficiency with statistical certainty. In the diagnosis of PPL, there will always be variability in performance, which may be attributable to patient-specific characteristics.

Introduction: Sedation during flexible bronchoscopy can be administered by a second physician, an anesthesiologist or as nurse-administered sedation (NAS). Propofol is often administered by non-anesthesiologists. It is unclear whether complications differ with various sedation protocols.

Methods: We searched PubMed for clinical trials of sedation during bronchoscopy and conducted a systematic review of complications (death ≤24 h post-procedure or intensive care unit (ICU) admission/predefined cardiopulmonary escalation [CPE]). Outcomes were analyzed according to the staff administering sedation, complexity of procedure, for propofol-containing regimes, and the ASA physical status classification of the patient.

Results: This analysis (120 articles, 39,475 procedures) showed a mortality rate of 0.01% for sedation bronchoscopy. ICU admission rate was 0.12%, and CPE was reported in 0.57%. Significantly higher CPE was recorded for anesthesiologists compared to NAS and second physicians (1.16% vs. 0.65% vs. 0.07%, respectively, p < 0.001) with higher ICU admission for NAS compared to anesthesiologists and second physicians (0.35% vs. 0.00% vs. 0.03%, respectively, p < 0.001). Endobronchial ultrasound did not increase complication rates. Admission to ICU and CPE remained <1% in propofol-containing regimes, although complications were slightly lower without propofol. Comparison of lower risk ASA 1-2 studies compared to studies with ASA 1-3 showed no significant difference in outcome.

Conclusion: Sedation bronchoscopy is a safe procedure. The staff administering sedation may react differently to periprocedural respiratory and cardiovascular events. Propofol application is not associated with a clinically relevant increase in complication rate. There is no evidence that ASA status is a predictor of individual risk at bronchoscopy.

Background: The TNM staging system is the cornerstone of lung cancer classification, providing a framework for prognosis and treatment planning in a universal nomenclature. The 9th edition of the TNM classification, released by the International Association for the Study of Lung Cancer (IASLC) and went into effect in January 2025, introduces refinements to lymph node (N) staging. Lymph node staging is performed minimally invasively using bronchoscopy with endobronchial ultrasound (EBUS). This article explores the latest updates on lymph node staging by EBUS and their implications for lung cancer management from the perspective of bronchoscopy.

Summary: The 9th edition of the TNM classification includes the subdivision of N2 lymph nodes into N2a single-station and N2b multiple-station involvement, but not the subdivision of N1 lymph nodes. This has implications not only for treatment but also for the number of lymph nodes sampled by EBUS. As there is no strict hierarchy of N2 lymph nodes, this poses challenges to the order in which N2 lymph nodes should be sampled. The development of a new thin EBUS device will enable sampling of peripheral N1 lymph nodes. This could influence future TNM classifications, given that there are pathological but not clinical differences in survival between purely peripheral and hilar N1 involvement.

Key messages: With respect to occult lymph node disease, EBUS remains fundamental in staging lung cancer. New technical developments will also enable sampling of peripheral N1 lymph nodes.

Introduction: Osteoprotegerin (OPG), a decoy receptor for receptor activator of NF-κB ligand (RANKL), serves as a biomarker for liver fibrosis severity. Our recent findings show OPG production in fibrotic lung tissue, though its specific cellular source and role in pulmonary fibrosis are unknown. We hypothesized that OPG is produced by fibroblasts and serves as a marker for pulmonary fibrosis progression.

Methods: We examined OPG expression in human and mouse control and fibrotic lung tissue and used primary human lung fibroblasts and murine precision-cut lung slices to study OPG production. Serum from idiopathic pulmonary fibrosis (IPF) patients and controls was analyzed to investigate correlations between OPG levels and disease status, as measured by lung function.

Results: OPG-protein levels were significantly higher in murine and human fibrotic lung tissue compared to control. OPG-protein levels in fibrotic mouse lung tissue correlated positively with collagen deposition. OPG-mRNA and protein production increased in mouse lung slices upon TGFβ stimulation. Isolated lung fibroblasts from IPF patients produced more OPG-protein than controls. Serum OPG levels in IPF patients negatively correlated with diffusing capacity to carbon monoxide. Serum OPG levels above 1,243 pg/mL were linked to disease progression in IPF patients.

Conclusion: OPG is produced by fibroblasts in lung tissue, associates with fibrosis, and may be a potential prognostic biomarker for IPF progression. Validation in a larger cohort is necessary to further explore OPG's role in pulmonary fibrosis and its potential for assessing fibrotic lung disease prognosis in individual patients.

Introduction: Current definitions of clinical remission (CR) use different tools and thresholds to define good asthma control. Their differential impact on CR rates in severe asthma is poorly understood.

Methods: Data from a real-world study in patients with SEA treated with benralizumab (imPROve Asthma, NCT04184284, total number of patients: 244 patients) were analyzed. Four-component CR (4-CR) was defined as no exacerbations, no systemic steroid treatment, stable or normal lung function, and good asthma control, for at least 12 months. The impact of 2 different asthma control measures (Asthma Control Questionnaire [ACQ] and Asthma Control Test [ACT]) with varying thresholds for good asthma control (ACQ: ≤1.5 or ≤0.75, ACT: ≥20 or ≥23) on CR rates was examined.

Results: Complete data on all remission criteria were available for 131 patients after 12 months of follow-up, and 85 patients after 24 months of follow-up. After 12 months, 4-CR criteria were fulfilled in 42.7% (ACQ-6 ≤1.5), 36.9% (ACT ≥20), 24.4% (ACQ-6 ≤0.75), and 21.5% (ACT ≥23) of the patients. After 24 months, 4-CR criteria were fulfilled in 39.2% (ACQ-6 ≤1.5), 31.8% (ACT ≥20), 22.8% (ACQ-6 ≤0.75), and 17.6% (ACT ≥23) of the patients.

Conclusion: CR is achievable in a substantial proportion of patients with SEA treated with benralizumab in a real-world setting. CR rates are strongly dependent on definitions of asthma control, with almost twice as high CR rates found using the ACQ-6 ≤1.5 criterion as compared with the ACT ≥23 criterion.

Introduction: High-flow nasal oxygen therapy (HFNO) for acute respiratory failure (ARF) has been used in the intensive care units (ICUs), but more recently also on respiratory wards (RWs). Little data are available regarding in-hospital, short-term and long-term mortality in the latter setting.

Methods: We performed a retrospective analysis of patients ≥ 16 years old treated with HFNO on the RW between 01/2020 and 09/2022 with a follow-up until 09/2023. We grouped patients by main diagnosis and do-not-intubate (DNI) order. Cox proportional hazard models were used.

Results: We analyzed 145 HFNO patients (36% women, median age 70 years [quartile range {Q1-Q3} 62-79], BMI 25.8 [Q1-Q3: 22.6-28.5] kg/m2) with ARF mostly due to COVID-19 (n = 84, 57.9%), other pneumonia (n = 25, 17.2%), and mixed other diagnoses (n = 36, 25%). A total of 71 (48.9%) patients started HFNO on ICU and continued on the RW, treatment was tolerated in 94% of patients. In-hospital mortality was 24.8% (n = 35), of whom 33 patients had a DNI-order. The mortality rates after 30 days, 90 days, and 1 year were 30% (n = 44), 38% (n = 54), and 43% (n = 62). Long-term mortality did not differ between diagnostic groups (p > 0.05), a higher BMI was associated with lower mortality (hazard ratio [HR] 0.95 [95% CI 0.91-0.99]). A DNI-order and a palliative setting were associated with higher mortality (1 year: HR 3.03 [95% CI 1.15-7.69], p = 0.024 and HR 4.01 [2.21-7.26], p < 0.001).

Conclusion: In our cohort of patients with ARF treated with HFNO, the underlying diagnosis of ARF was not associated with an increased mortality risk. In DNI patients, RW HFNO allows for advanced care without burdening ICU resources.

In the article "National Registry for Home Mechanical Ventilation in Children from Turkey" [Respiration. 2025;104(6):377-387. https://doi.org/10.1159/000543343] by Neval Metin Çakar et al., the authors noticed an error in reference #12, which was inserted erroneously during citation formatting. It incorrectly refers to an unrelated article, while it should have only indicated the abbreviation spinal muscular atrophy (SMA) within the text.The corrected sentence should read as follows:"This group comprised of 54.3% (n = 150) with spinal muscular atrophy (SMA) type 1, 29.1% (n = 81) with other neuromuscular diseases, 9% (n = 26) with Duchenne muscular dystrophy (DMD), and 7% (n = 19) with SMA-2."The original online article has been updated to reflect this.