Respiration最新文献

Introduction: Shape-sensing robotic-assisted bronchoscopy (ssRAB) was shown to be superior in diagnosing peripheral pulmonary nodules (PPNs) compared to conventional bronchoscopy. Although RAB is established in the USA since 2019, the ION™ Endoluminal System was not CE marked in Europe until 2023.

Methods: The first prospective European single-center, premarket study, conducted between 2022 and 2023, assessed the diagnosis of PPNs with ssRAB, using the ION™ Endoluminal System. Patients with suspected lung cancer or metastasis, PPNs of 1-3 cm, and ≥3 airway generations out were included in this study and followed up for up to 6 months. The primary outcome was the rate of tool-in-lesion (TIL), confirmed by mobile cone-beam computed tomography or with malignant index biopsy finding. Secondary outcomes included procedural characteristics, diagnostic yield, and adverse events.

Results: A total of 43 patients with a mean nodule size of 19.2 × 16.9 × 15.8 mm, a mean distance of 17.4 ± 15.5 mm to the pleura, and mean 6.6th generation of airway were analyzed. TIL was achieved in 90.7% of all cases. Strict diagnostic yield was 67.4% and sensitivity for malignancy was 78.6%. No pneumothorax and no adverse events were reported outside of 3 cases of Nashville ≤2 bleeding. Predictors for successful diagnosis were the inner or middle third location (OR: 4.19, p = 0.039), CT bronchus sign (OR: 4, p = 0.044), and distance from pleural wall (OR: 1.05, p = 0.048). The lower lobe location (OR: 0.06, p < 0.001) was associated with nondiagnostic cases.

Conclusion: The first European cases show ssRAB is a safe procedure with promising results for enabling diagnosis of PPNs.

Introduction: Drug-induced interstitial lung disease (DILD) involves different pathogenic mechanisms, and it is difficult for clinicians to identify the culprit drug. There is currently no systematic research that allows us to understand the comprehensive situation of potential risk drugs and culprit drugs for DILD.

Methods: This study retrospectively analyzed all adverse events related to DILD in FAERS, compiled a list of potential risk drugs leading to DILD and calculated the reporting ratio. In addition, all drugs within the list were detected using disproportionality analysis, a list of culprit drugs was developed based on the signal detection results, and the signal distribution characteristics were summarized.

Results: We obtained 108,891 DILD-related reports and identified 1,445 potential risk drugs from them. Overall, the drug with the highest number of reports was methotrexate, followed by amiodarone, nivolumab, pembrolizumab, and rituximab. Classifying all potential risk drugs (second-level ATC subgroup), the subgroup with the highest number of reports is antineoplastic agents. Finally, we determined the list of culprit drugs, and 171 drugs showed positive signals by signal detection, while the other 1,274 drugs were determined to be negative, with amiodarone obtaining the highest number of positive signals. All the culprit drugs were classified and distributed them positively and negatively. The number of drugs with positive signals is less than that with negative signals, and antineoplastic agents (L01) have the highest proportion among all positive drugs.

Conclusion: This study comprehensively displays all drugs related to DILD from a landscape perspective, promoting the rational use of drugs in clinical practice.

Introduction: The aim of our study was to identify routine serum biomarkers that may be related to alpha-1 antitrypsin deficiency lung disease phenotypes and severity.

Method: Observational, cross-sectional, multicentre study conducted in patients with a Pi*ZZ genotype. Serum biomarkers, including neutrophil/lymphocyte ratio (NLR), eosinophil/lymphocyte ratio (ELR) and platelet/lymphocyte ratio (PLR), were calculated. Data were analysed to establish possible associations between biomarkers and lung function and lung phenotypes.

Results: Among the 897 patients included, 48.4% were men with a mean age of 53.9 (standard deviation 14.7) years. Patients with chronic obstructive pulmonary disease (COPD) (n = 337) had higher haemoglobin levels (15.3 mg/dL vs. 13.9 mg/dL, p < 0.001), gamma-glutamyl transferase (GGT) (50.1 IU/L vs. 35.7 IU/L, p < 0.001), eosinophils (0.22 109/L vs. 0.19 109/L, p < 0.001), NRL (2.55 vs. 1.86), PLR (132.6 vs. 119.8), and ELR (0.12 vs. 0.1) compared to those without COPD. In multivariate analysis, older age, male sex, higher haematocrit, elevated alanine transaminase and GGT levels, and a higher NRL and PLR were associated with a worse forced expiratory volume in the first second (FEV1) (%). A higher Charlson score, elevated haematocrit and white cell count, as well as increased levels of AAT, aspartate aminotransferase (AST), GGT, and PLR were associated with worse carbon monoxide transfer coefficient (KCO) (%). Exacerbations were associated with female sex, and a higher PLR.

Conclusion: Some blood biomarkers are increased in patients worse lung function. However, the correlations between these biomarkers and the different measures of lung function are weak, and thus, identifying a single routine biomarker that accurately predicts disease severity and progression is challenging.

Introduction: Previous studies yielded inconsistent results regarding whether bronchoscopic lung volume reduction using endobronchial valves (EBVs) improves pulmonary ventilation. The aim of this study was to evaluate changes in ventilation following EBV treatment using a novel technique for assessing specific pulmonary ventilation: X-ray velocimetry (XV LVAS, 4DMedical, Los Angeles, CA, USA).

Methods: Pulmonary ventilation was assessed using XV pretreatment and 6 weeks after treatment. The main outcome was mean specific ventilation (MSV) (mL/mL) which is defined as the volume change in a lung region (from start to end of inspiration), divided by the volume of that region at the start of inspiration.

Results: Nineteen patients were included (79% female, mean FEV₁: 30% of predicted, median RV: 207 %pred). After EBV treatment, RV decreased significantly by 0.90 L (interquartile range: -1.2 to -0.67, p < 0.001). EBV treatment resulted in a significant increase in MSV of the whole lung. When stratifying by treated and non-treated lungs, a significant increase in MSV was found in the treated lung, while a significant decrease was found for the non-treated (contralateral) side. No significant associations were found between changes in X-ray velocimetry (XV) measurements and changes in clinical outcomes.

Conclusion: For the first time, XV was utilized to measure specific pulmonary ventilation before and after EBV treatment. Our results demonstrate an overall increase in pulmonary ventilation across the whole lung, driven by an increase in the treated lung, despite a decrease in the non-treated lung. No association was observed between changes in pulmonary ventilation and changes in clinical outcomes.

Introduction: Long-term home noninvasive ventilation (LTH-NIV) supports patients with chronic respiratory failure. The S3-NIV questionnaire is an easy and quick tool to evaluate outpatients initiated to home mechanical ventilation. The aim of our study was to translate and validate the Italian version of the S3-NIV questionnaire and test its internal consistency and factorial structure, providing with Italian cultural adaptation of the original S3-NIV questionnaire.

Methods: This is a prospective, national, observational, multicenter study enrolling consecutive outpatients accessing between December 2023 and June 2024 to a dedicated ambulatory for chronic respiratory failure requiring LTH-NIV for different underlying diseases (i.e., chronic obstructive pulmonary disease, neuromuscular disorders, obesity hypoventilation syndrome). Internal consistency was assessed using Cronbach's alpha.

Results: The translation and back-translation process from the English version was performed. A total of 228 out of 340 screened patients were enrolled Internal consistency of the total score was good (Cronbach's α coefficient of 0.84) as well as for the "respiratory symptoms" and the 'sleep and side effects' subdomains (0.82 and 0.74, respectively). Kaiser exploratory analysis confirmed good homogeneity: 0.85.

Conclusion: The S3-NIV questionnaire Italian translation and cultural adaptation has good global reliability and internal consistency. This tool has been confirmed to be a simple, quickly available, and easy-to-use tool for the outpatients' clinical assessment of stable patients with chronic respiratory failure initiated on LTH-NIV.

Background: Lung cancer remains the leading cause of cancer-related mortality worldwide. Although surgical resection and stereotactic body radiation therapy are standard treatment options for early-stage disease, both are limited by procedural morbidity and ineligibility among high-risk patients. Similarly, percutaneous approach with image-guided ablation is associated with pneumothorax and pleural injury. Advances in navigation, imaging, and device design have enabled endoscopic ablation to emerge as a minimally invasive technique capable of targeting peripheral and central lesions under real-time image guidance.

Summary: Endoscopic ablation techniques, comprising radiofrequency, microwave, laser, vapor, cryoablation, photodynamic therapy, pulsed-electric field ablation, and intralesional chemotherapy, enable precise bronchoscopic delivery of localized therapy. Early feasibility, safety, and clinical data demonstrate high technical success, favorable short-term safety, and potential immunologic synergy when combined with systemic therapy. Nonetheless, several challenges remain, including limited access to subsegmental lesions, variability in ablation margins, and lack of long-term outcomes. Despite these limitations, ongoing advances in device design, navigation, and imaging, such as robotic-assisted bronchoscopy and cone-beam computed tomography, are enhancing the procedural precision and therapeutic reach. This review synthesizes current evidence on endoscopic ablation, focusing on emerging technologies, clinical applications, and key research gaps.

Key messages: Endoscopic ablation represents a promising, lung-sparing treatment for lung malignancies. Ongoing technological advances in navigation, imaging, and integration are enhancing its applicability in local tumor control. Large, prospective trials are required to validate oncologic efficacy, optimize procedural parameters, and establish endoscopic ablation's role within multimodal lung cancer management.

Introduction: Cystic fibrosis (CF) is associated with a high respiratory symptom and treatment burden. Elexacaftor/tezacaftor/ivacaftor (ETI) provides substantial improvements in physiological outcomes such as respiratory function and sweat chloride. This study sought to comprehensively examine an area of limited research in this field: the lived experiences of adults with CF after ETI initiation.

Methods: Adults with CF completed semi-structured interviews at least 6 weeks following the initiation of ETI. Participants shared their experiences regarding respiratory-related symptoms, airway clearance routines, and their capacity to participate in physical activity. Interviews were audio-recorded, transcribed verbatim and analysed using the Framework Method.

Results: Seventeen participants completed interviews (FEV₁ range before ETI initiation 31 to 87 % predicted). All participants reported improvements in respiratory-related symptoms including cough, sputum expectoration, dyspnoea, and chest tightness. As a result, there was a reduction in participants airway clearance treatment burden and improvements in their capacity to participate in physical activity, health-related quality of life and outlook for the future. The overall theme highlighted in this study was that ETI had "completely changed everything" and they can now do "everything I wasn't able to do before" due to the reductions in symptom and treatment burden.

Conclusion: Participants consistently described their experiences with ETI in positive terms. The results of this study confirm that ETI is in fact perceived to be a "miracle drug" and has had a transformative effect on the everyday lives of adults with CF through improved HRQoL and overall wellbeing, which led to positive views regarding their future with CF and ongoing medical care.

Introduction: Medical thoracoscopy (MT) is a minimally invasive procedure primarily used for diagnosing pleural diseases. However, its therapeutic role, especially in complex pleural infections, is underexplored. Rising pleural disease incidence and the need for less invasive treatment options have spurred interest in enhancing MT's capabilities. Disposable articulated wristed instruments, initially designed for laparoscopic surgery, could offer improved dexterity and precision, potentially expanding MT's therapeutic use.

Case series: We present 3 patients with complex pleural effusions managed with MT, utilizing articulated, robotic-like instruments (ArtiSential by LivsMed) under monitored anesthesia care at a tertiary care center: a 67-year-old man with a recurrent, loculated exudative effusion underwent dual-port thoracoscopy due to high suspicion of tuberculous pleurisy versus malignancy. The use of articulated instruments enabled precise adhesiolysis and effective drainage, which ultimately facilitated diagnosis and successful initiation of antituberculosis treatment. A 64-year-old male with suspected malignant pleural effusion underwent single-port thoracoscopy. The use of an articulated dissector and an articulated monopolar spatula allowed for precise adhesiolysis, facilitating both diagnostic sampling and therapeutic intervention, including successful placement of a tunneled pleural catheter in a cleared pleural space. A 64-year-old COPD patient with anaerobic empyema had dual-port thoracoscopy. Articulated tools allowed precise debridement and evacuation without the need for adjunct fibrinolytic therapy.

Conclusion: These cases demonstrate that articulated wristed instruments can potentially enhance MT's precision and reach in complex pleural spaces. Their use broadens therapeutic options for patients unsuitable for surgery and supports MT as a minimally invasive, effective intervention. Continued innovation and research are essential to validate benefits on clinical outcomes and healthcare utilization, ensuring MT remains a vital tool in managing pleural diseases.

Introduction: In patients with benign tracheal stenosis (TS) deemed inoperable, silicone stents is an effective alternative. Although both straight and hourglass-shaped stents are available, little is known on the specific suitability of each stent. We aimed to evaluate the potential clinical benefit of choosing a specific stent for each case.

Methods: We compared clinical outcomes in patients undergoing stent placement, in two groups: group 1, when only straight silicone stents were available and group 2, when we could choose either straight or hourglass stent, depending on the anatomic characteristics of the stenosis. A scoring system based on clinical/functional/bronchoscopic characteristics was used to evaluate complications severity.

Results: Between 2008 and 2023, 37 patients underwent tracheal stenting for PITS, comprising group 1 (n = 8) and group 2 (n = 29). No differences were observed between groups regarding stenosis type, location, length, or baseline dyspnoea. Group 2 demonstrated a significantly lower stent/patient ratio (1.24 vs. 1.87, p = 0.001) and higher rates of clinical success (29 vs. 6 cases, p = 0.014). The Complication Severity Index (CSI) was significantly lower in group 2 (0.8 vs. 1.3, p = 0.016). Patients bearing straight stents in group 2, had a lower stent/patient ratio compared with group 1 (1.50 vs. 1.87, p = 0.044) and improved outcomes (10 vs. 6 cases, p = 0.043), with a lower CSI (0.85 vs. 1.3, p = 0.025). In group 2, hourglass stents had a lower stent/patient ratio than straight stents (1.14 vs. 1.50, p = 0.038).

Conclusion: Choosing the fittest stent for each type of TS generates fewer complications and increased efficacy. Our results indicate that hourglass stents may comply better to annular TS.

Introduction: Weakening of respiratory reserve is the primary factor associated with difficult or prolonged weaning. Despite being the most accurate method, the transpulmonary pressure-derived respiratory reserve is rarely employed before weaning due to the need for specialized equipment and invasive procedures. The objective of our study was to clarify the predictive value of respiratory reserve, as assessed by ventilator parameters during spontaneous breathing trials (SBTs), for weaning outcomes.

Methods: The single-center study was retrospectively conducted from October 2022 to July 2023. Ventilator parameters related to respiratory reserve during SBTs were recorded, including cough peak expiratory flow, airway occlusion pressure (P0.1), rapid shallow breathing index (RSBI), dynamic lung compliance (Cdyn), airway resistance (Raw), and variant concavities of flow index (FI), which was determined through nonlinear fitting analysis of the inspiratory flow-time curve.

Results: A total of 2,508 respiratory cycles from 93 patients during SBTs were collected. Although all enrolled patients met the current criteria for weaning, 29 (31.2%) of them still experienced difficult or prolonged weaning. However, it was difficult to predict patients who would fail weaning in advance based on any single ventilator parameters related to respiratory reserve during SBTs mentioned above. Then, machine learning (ML) was applied for systematic analysis. The RandomForestEntr model was selected based on automated machine learning (AutoML) for better performance in predicting weaning (AUC of ROC: 0.941, 95% CI: 0.696-0.972). And the visualized output about the possible reasons of difficult or prolonged weaning for individual patients was presented.

Conclusion: Respiratory reserve assessed by ventilator parameters during SBTs could predict weaning outcomes for critically ill patients. And they should be analyzed comprehensively rather than in isolation. AutoML is a promising method worthy of consideration. And prospective studies with external validation are needed.