Respiration最新文献

Introduction: Bronchial rheoplasty with non-thermal pulsed electric field (PEF) ablation has excellent developmental potential for the therapy of chronic bronchitis (CB) subtypes of chronic obstructive pulmonary disease (COPD). However, the volume of reported clinical studies is quite limited. Also, repeated and missed ablations are involved during the procedure, affecting the targeted therapy and PEF further development. Evaluating the feasibility, safety, and efficacy of a novel navigated PEF ablation system in the therapy of CB, promoting the COPD therapeutic field toward a new stage of greater precision and efficiency.

Methods: First, real-time navigated bronchial rheoplasty were performed in 18 live pigs by a novel navigated PEF ablation system (variable-diameter navigated PEF ablation catheter with a length of 1.4 m and an outer diameter of 1.5 mm) with 84 days of follow-up. Subsequently, bilateral bronchial rheoplasty was conducted in 4 patients with CB using this system. Changes in CAT scores, mMRC scores, CT tests, and lung function were explored during the 6-month follow-up. The feasibility, safety and efficacy of the technique were further evaluated.

Results: Real-time navigated bronchial rheoplasty was performed successfully in 18 live pigs without any serious complications. Pathologic results showed complete recovery of mild tissue inflammation during follow-up from 4 h to 28 days. In the clinical trial, a total of 8 PEFs were performed in 4 patients with CB subtype COPD, achieving a technical success rate of 100%. There were no device- or procedure-related serious adverse events within 6 months.

Conclusions: Precision-targeted ablation of patients with CB by a novel navigated PEF ablation system is a safe, feasible, and effective approach.

Introduction: Pulmonary vascular abnormalities coexist with interstitial lung disease (ILD), leading to a spectrum of physiologic impairments. We hypothesized that ILD patients with exercise intolerance have a heterogenous hemodynamic profile when assessed by invasive cardiopulmonary exercise testing (iCPET).

Methods: From January 2018 to December 2023, we prospectively performed iCPET for several conditions. The primary outcome of the study was to assess the hemodynamic phenotypes both at rest and during exercise of ILD patients with exercise intolerance, which cannot be fully explained by the severity of ILD.

Results: Of the 43 ILD patients included in the study, 10 (23%) had no pulmonary hypertension (PH), 16 (37%) had no PH with pulmonary vascular resistance (PVR) >2 WU, 7 (16%) had precapillary PH, 7 (16%) had postcapillary or combined pre- and postcapillary PH, and 3 (7%) had unclassified PH. Four (9%) patients had exercise PH. Forced vital capacity, diffusion capacity for carbon monoxide, peak oxygen consumption, and resting partial pressure of oxygen (PaO₂) were significantly lower across the no PH to precapillary PH spectrum. Peak exercise PaO₂ decreased (97 ± 25, 73 ± 15, and 62 ± 10 mm Hg, p = 0.001) while mPAP/CO slope (1.9 ± 1.1, 3.1 ± 2.1, and 5.1 ± 2.7, p = 0.009) and PAWP/CO slope (0.9 ± 0.7, 0.9 ± 0.7, and 3.0 ± 3.0, p = 0.007) increased from no PH, to no PH with high PVR, to precapillary PH. No associations were noted for gender, presence of fibrotic ILD and scleroderma, and mPAP/CO >3 WU across this spectrum.

Conclusion: Patients with ILD and exercise intolerance have several hemodynamic phenotypes with parameters that reveal worse exercise performance from no PH to no PH with elevated PVR to precapillary PH.

This is the 4th edition of the S2k cough Guideline (based on a structured consensus among a representative committee) of the German Respiratory Society (DGP) for specialists, written by respiratory, internal medicine, allergy, ear-nose-throat, gastroenterology specialists, speech therapists and physiotherapists - accredited by their respective scientific societies. Importantly, a patient representative was also involved. The Guideline was coordinated under the guidance of a representative from AWMF (Association of the Scientific Medical Societies in Germany). With regard to specific questions, we intend to supplement the cough guideline of the German Society of General and Family Medicine (DEGAM). Compared to the earlier versions 1-3 of the DGP cough guideline, which had the character of a monograph, the concept of this guidelines is completely new. In a modified Delphi process, the authors developed 12 key questions; they were answered in the guideline conference and the recommendations were graded strong), weak or insufficient on the basis of the available evidence. A brief scientific background to the respective questions was then compiled by expert groups of authors. In some cases, new diagnostic algorithms were created for acute, subacute and chronic cough. The significantly reduced scope and improved overview make the guideline easier to use in daily practice. It has also been incorporated into the Leila Pro smartphone Application and can be accessed using its convenient functions (see https://www.leila.de/de/).

Invasive mechanical ventilation remains a cornerstone in the treatment of critically ill patients suffering from acute respiratory failure, providing life-sustaining gas exchange while necessitating careful selection of modes and settings to maximize benefit and minimize harm. This guideline-derived review synthesizes updated, critically appraised, and evidence-based recommendations on choosing ventilatory modes and setting key parameters in adults with acute respiratory insufficiency. Building on a systematic GRADE process and presented digitally in the MAGICapp, the 2025 guideline for the German, Austrian, and Swiss healthcare context retains a pragmatic taxonomy of ventilatory modes and updates several clinical recommendations. In invasively ventilated patients with moderate-to-severe ARDS, early neuromuscular blockade is no longer favored; instead, early assisted strategies that allow spontaneous breathing are suggested when clinically appropriate. Pressure-controlled, minute ventilation-supporting modes that enable spontaneous breathing during both inspiration and expiration may be considered in hypoxemic respiratory failure, acknowledging very low certainty of evidence and notable heterogeneity across trials. For the first time, our guideline issues recommendations on adaptive ventilation modes. Some adaptive modes (e.g., ASV/INTELLiVENT-ASV) and neurally adjusted ventilatory assist may be considered on a case-by-case basis, whereas flow- and volume-proportional assist ventilation (e.g., PAV/PAV+) is not recommended given low-certainty evidence and frequent intolerance. Parameter recommendations emphasize lung-protective ventilation with VT ≈ 6 mL/kg predicted body weight (range 4-8 mL/kg), a plateau pressure ≤30 cm H₂O, and a driving pressure ≤14 cm H₂O. Positive end-expiratory pressure should be higher in moderate/severe ARDS and individualized using bedside physiology, while oxygen targets of SaO₂/SpO₂ 92-96% or PaO₂ 70-90 mm Hg balance hypoxemia and hyperoxia risks. Continuous cardiorespiratory monitoring and capnography for tube placement confirmation and trend assessment are endorsed. Collectively, these recommendations aim to support safe, effective, and implementable ventilatory care while transparently conveying where certainty of evidence remains limited.

Background: Incidental pulmonary nodules (IPNs) detected during routine thoracic CT scans offer a promising opportunity to shift lung cancer (LC) diagnoses toward earlier, more curable stages across a broad patient population. Despite their high potential to reduce LC-related mortality, the complexity and heterogeneity of existing guidelines, combined with inefficient follow-up processes, continue to limit the diagnostic and therapeutic benefits of IPN detection.

Summary: This article examines the systemic barriers to effective IPN management and outlines strategic solutions, including automation and structured workflows as well as standardized patient communication. With the recent implementation of national lung cancer screening (LCS) programs, new opportunities arise to synergize infrastructures and optimize pulmonary nodule management within a unified framework.

Key message: Therefore, a clearer understanding of how IPNs should be managed - and how they can be integrated into broader early detection strategies - is essential for a truly holistic approach to early LC detection.

Introduction: Optimal initiation and management of long-term home non-invasive ventilation (LTH-NIV) therapy requires a personalised approach that may not be possible within some healthcare systems. This survey of Italian physicians determined current practices regarding LTH-NIV initiation and follow-up in patients with chronic hypercapnic chronic obstructive pulmonary disease (COPD), areas for process improvements, and use of telemonitoring.

Methods: A 35-question survey was developed then sent via email for completion using computer-assisted web interviewing methodology. Respondents were Italian hospital-based physicians identified using a healthcare professional database who had 3 years' experience in pulmonology, treated/followed up at least 50 patients on NIV, and consented to participate.

Results: Sixty of 71 physicians approached completed the online survey. Of these, 41/60 (68%) said that LTH-NIV prescription followed hospitalisation for acute COPD exacerbation. The most important clinical aspects to monitor early after discharge and during long-term follow-up were reported as mask fit and patient quality of life. Physicians reported a high workload for management of patients on LTH-NIV but felt that many therapy management tasks could be performed by other providers, especially outpatient pulmonologists and homecare providers. Only 32% of respondents were currently using telemonitoring; reasons for non-use were lack of human resources (63%) or regulatory framework (37%), and cost/reimbursement issues (22%).

Conclusion: These data highlight substantial differences between LTH-NIV clinical practice for chronic hypercapnic COPD in Italy and current guidelines, suggesting that guideline-mandated processes may not be achievable or sustainable in real-world settings. Involvement of homecare providers and use of telemonitoring could help improve the management of LTH-NIV therapy.

Introduction: Loss of muscle mass and sarcopenia are associated with poor prognosis in chronic respiratory illnesses and are currently emerging as coexisting conditions that deserve attention in patients with idiopathic pulmonary fibrosis (IPF). However, the exact impact of muscle changes in this deadly disease is not entirely understood. Our study aimed to investigate the role of muscle loss/myosteatosis assessed by computed tomography in the short- and long-term survival of patients with IPF treated with antifibrotics.

Methods: Ninety-six patients with IPF (16 females, 80 males) were retrospectively enrolled between March 2014 and December 2022. Demographic, functional, and radiological data were collected at diagnosis. Area and density of the paravertebral muscle at the level of the 12th thoracic vertebra were collected, and myosteatosis was defined as Hounsfield Unit (Hu) value <30; moreover, using the same segmentation, 54 radiomic variables were extracted.

Results: Forty-four out of 96 patients (46%) had myosteatosis. Patients with myosteatosis were older (74.6 vs. 67.4 years; p < 0.001) with lower GERD comorbidities (25% vs. 54%; p = 0.006) compared with patients with preserved muscle density. Patients with myosteatosis had lower 2-year survival (p = 0.03), but no significant differences occurred for the overall survival. In the multivariable Cox regression analysis, myosteatosis was an independent predictor of 2-year mortality [HR 6.13, 95% CI (1.62-23.12); p = 0.007].

Conclusion: Myosteatosis is already present in half of the IPF population at diagnosis and impacts short-term survival after 2 years. Our findings highlight the importance of a fully comprehensive assessment of IPF patients to address early nutritional intervention and/or rehabilitation programs.

Introduction: Available endobronchial valves (EBVs) for lung volume reduction in severe emphysema are limited in variety and predominantly feature complex metal-silicone designs (e.g., Zephyr®). This study aimed to introduce a novel, all-silicone endobronchial valve (ESV) designed to simplify manufacturing and potentially improve biocompatibility.

Methods: A preclinical study implanted ESVs or Zephyr® EBVs (1:1) into unilateral caudal lobes of 8 pigs, assessed using computed tomography, bronchoscopy, and necropsy over 6 weeks. A first-in-human (FIH) trial enrolled 3 severe emphysema patients (male, aged 48-72 years, collateral ventilation-negative). ESVs were placed using a bronchoscope under general anaesthesia. Outcomes included procedural success, safety, target lobar volume reduction, lung function, quality of life, and exercise capacity at baseline and 3 and 6 months.

Results: Preclinically, all valves (12 ESV, 12 Zephyr®) were successfully implanted and removed. Complete target lobe atelectasis occurred by 6 weeks in all animals, without major adverse events; localised granulation was observed. In the FIH trial, all ESVs were successfully deployed (procedure time: 5-20 min). Target lobar volume reductions occurred at 6 months in 2 of 3 cases (Case 1: 1.5 L, Case 2: 0.4 L). Emphysema volume decreased at 3 and 6 months. Lung function, quality of life, and exercise capacity showed trends toward improvement. One patient experienced an acute exacerbation of chronic obstructive pulmonary disease; no pneumothorax, pneumonia, or haemoptysis occurred.

Conclusion: Overall, ESV was shown to have an initial feasibility for endobronchial lung volume reduction in humans. Further studies are needed to evaluate the sustained effects.

Introduction: The sedation required for rigid medical thoracoscopy may be associated with hypoventilation and intermittent hypoxaemia. High-flow oxygen administration has been shown to decrease hypoxaemia during sedation for flexible bronchoscopy, a procedure using similar sedation protocols to medical thoracoscopy.

Methods: An investigator-initiated randomised controlled trial to compare conventional oxygen (starting at 4 L/min) to high-flow nasal oxygen (starting rate 60 L/min and fraction of oxygen 0.6) during sedation for medical thoracoscopy. The mean nadir oxygen saturation (SpO₂) during the procedure was the primary endpoint.

Results: Between February 2022 and June 2023, 36 patients were randomised to either conventional oxygen (n = 20) or high-flow oxygen (n = 16). The majority of participants (20/36, 55.6%) were male, and the mean age was 75.4 ± 10.4 years. The nadir SpO₂ was 88.3% using high flow as compared to 85.0% for conventional oxygen (p = 0.20). The average SpO₂ (96.3% vs. 96.2%, p = 0.81) was similar between groups. There was a tendency towards a higher peak P_tcCO2 in the conventional oxygen group (49.6 mm Hg vs. 55.5 mm Hg, p = 0.13).

Conclusion: Oxygen supplementation using nasal high flow provides similar SpO₂ to conventional nasal oxygen during sedation for rigid medical thoracoscopy.

Introduction: Well-selected patients with advanced emphysema and hyperinflation benefit from lung volume reduction (LVR), including bronchoscopic LVR with endobronchial valves (EBVs) and LVR surgery (LVRS). As bilateral EBV placement may not be advisable, an alternative approach is required. This prospective case series evaluates hybrid LVR, where contralateral LVRS is performed for patients with functional decline despite persistent atelectasis post-EBV.

Case presentation: Six patients underwent hybrid LVR with a median baseline pre-EBV FEV₁ of 750 mL (range, 430-880), residual volume (RV) of 226% (187-293), and 6-min walking distance (6MWD) of 342 m (245-378). Baseline SGRQ was 70 points (47-86). Time between EBV and LVRS was 698.5 days (403-1,027), and all had persistent atelectasis at the time of contralateral LVRS. Post-LVRS hospital stay was 5.5 days (2-44), with complications in 2 patients (chest tube replacement, arrhythmia requiring upgrade to intensive care unit). There was no 90-day mortality. Compared to pre-EBV, 6 months post-LVRS, FEV₁ improved by 80 mL (-20 to 410), RV decreased by 1,000 mL (740-1,870), 6MWD increased by 59.5 m (-65 to 123), and SGRQ dropped by 11.5 points (-33 to 19).

Conclusion: This case series on hybrid LVR demonstrates its potential to improve lung function and quality of life in selected patients who experience a deterioration in lung function following successful EBV placement.