Respiration最新文献

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: Noninvasive ventilation (NIV) requires ongoing monitoring to ensure optimal therapeutic efficacy. The S3-noninvasive ventilation (S3-NIV) questionnaire was recently developed as a brief, repeatable, self-administered tool for the routine clinical evaluation of patients on long-term home NIV. This study aimed to produce an Arabic translation and cultural adaptation of the S3-NIV questionnaire and to assess its psychometric properties.

Methods: This was a descriptive, cross-sectional study involving patients with stable chronic respiratory disease treated with long-term home NIV. The Arabic version of the S3-NIV questionnaire was developed from the original French version through a standardized translation and back-translation process. The resulting instrument was evaluated for reliability and construct validity.

Results: A total of 150 patients were enrolled. The Arabic S3-NIV questionnaire demonstrated good internal consistency for the total score (Cronbach's alpha = 0.76; 95% CI: 0.69 to 0.83) and for the "respiratory symptoms" domain (Cronbach's alpha = 0.793; 95% CI: 0.728 to 0.858). The "sleep and side effects" domain showed lower reliability (Cronbach's alpha = 0.573; 95% CI: 0.266 to 0.880). Both the total score and the two subscale scores showed weak negative correlations with the Epworth Sleepiness Scale (ESS), modified Medical Research Council (mMRC) scale, pain visual analogue scale (VAS), and fatigue VAS. Exploratory factor analysis explained 54.6% of the total variance, supporting the internal structure of the Arabic version.

Conclusion: The Arabic version of the S3-NIV questionnaire demonstrates acceptable reliability and construct validity, particularly for the assessment of respiratory symptoms. It is a suitable tool for routine clinical use in Arabic-speaking patients receiving home NIV, although further refinement of the "sleep and side effects" subscale is recommended.

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.

Introduction: Patients with bronchiectasis frequently exhibit impaired mucociliary clearance and compromised immunity, rendering them more susceptible to Aspergillus-related lung diseases. Positive Aspergillus IgG not only indicates potential aspergillosis but also suggests the possibility of chronic Aspergillus infection or exposure. We aimed to evaluate the implications of positive Aspergillus IgG in bronchiectasis patients without aspergillosis.

Methods: A total of 235 patients diagnosed with bronchiectasis were prospectively enrolled from three tertiary care hospitals. Serum samples were obtained for the detection of Aspergillus IgG. The associations between Aspergillus IgG levels and clinical outcomes were subsequently analyzed.

Results: Aspergillus IgG was positive in 30% (70/235) of the patients. Those with positive Aspergillus IgG demonstrated significantly higher modified Medical Research Council (mMRC) scores (p = 0.001), poorer lung function (p = 0.027), and more severe disease (p = 0.005). Additionally, this group experienced more exacerbations (p = 0.001) and hospitalizations (p = 0.001) in the preceding year. Although there was no significant difference in mortality between the two groups during the 12-month follow-up, patients with positive Aspergillus IgG had more frequent exacerbations and hospitalizations at both 6-month and 12-month follow-ups post-discharge. Multivariate analysis revealed a significant association between positive Aspergillus IgG and an increased risk of exacerbations in bronchiectasis (hazard ratio 1.905, 95% confidence interval: 1.179-3.077, p = 0.013).

Conclusion: Positive Aspergillus IgG is prevalent among bronchiectasis patients. Furthermore, positive Aspergillus IgG is associated with poorer lung function, increased disease severity and more frequent exacerbations in patients with bronchiectasis.

Endobronchial valve implantation to accomplish bronchoscopic lung volume reduction (BLVR) has been shown to improve pulmonary function, functional status, and dyspnea in patients with advanced emphysema complicated by hyperinflation without interlobar collateral ventilation. Patient selection and periprocedural management are largely derived from clinical trial inclusion criteria and limited to expert opinion. No consensus recommendations are available to guide practical aspects of BLVR. An international group of experts were invited to participate and were surveyed broadly regarding their BLVR-related practices, from which specific topics were selected by the group, followed by literature review on these topics. Recommendations regarding selected topics were formulated over three voting rounds using a modified Delphi technique requiring at least 80% consensus agreement. A total of 21 recommendations reached consensus and are detailed herein. One recommendation failed to reach consensus, and two other topics were found to have insufficient evidence to make specific recommendations. These consensus recommendations offer guidance on practical aspects of patient selection and periprocedural management topics related to BLVR with endobronchial valves and highlight gaps in current knowledge requiring further research.

Introduction: Although calcified mediastinal lymph nodes are often clinically silent, they can eventually compress vital structures, such as the trachea or bronchi, necessitating intervention. Traditional surgical resection can be risky for certain patients. We present a pioneering case in which endobronchial ultrasound (EBUS)-guided transbronchial resection effectively relieved bronchial obstruction caused by calcified lymph nodes.

Case presentation: A 59-year-old male with a history of treated tuberculosis presented with a 4-month history of persistent cough, sputum, and dyspnea. Imaging revealed calcified mediastinal lymph nodes compressing the right intermediate bronchus, with mucus plug formation and obstructive pneumonia. After attending a team consultation in which the risks were reviewed, the patient declined surgery. Hence, an EBUS-guided transbronchial resection was performed under general anesthesia. Two calcified lymph nodes were resected using a high-frequency needle knife and forceps under real-time ultrasound guidance. No perioperative complications occurred. The patient's respiratory symptoms resolved, and follow-up bronchoscopy at 4 months showed a fully healed airway without restenosis.

Conclusion: This case highlights the feasibility and safety of EBUS-guided transbronchial resection as a minimally invasive treatment for symptomatic mediastinal lymph node calcification. EBUS may potentially be a viable alternative for patients in whom thoracic surgery is contraindicated or declined.

Introduction: Radial endobronchial ultrasound (rEBUS)-guided transbronchial biopsy (TBB) is the most used technique for the diagnosis of peripheral pulmonary lesions. However, the TBB cannot be performed under simultaneous ultrasound guidance as the rEBUS probe has to be removed prior to the biopsy. To provide an endobronchial imaging-based guided TBB, the safety and feasibility of cryobiopsy under simultaneous probe-based confocal laser endomicroscopy (pCLE) control is analyzed for the first time in this prospective pilot study.

Methods: Fifteen patients with a pulmonary lesion suspicious for malignancy were enrolled in this prospective pilot trial from September 2023 to December 2024 at the Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, Austria. After identifying the lesion by the rEBUS, a cryoprobe and an AQ Flex™ probe were inserted simultaneously under fluoroscopic guidance. Based on the pCLE images, the position of the cryoprobe was optimized and TBB were performed. The safety and feasibility were evaluated.

Results: In 11 patients in whom the pulmonary lesions were identified by rEBUS, a transbronchial cryobiopsy could be performed under simultaneous pCLE guidance without any complications. The cryoprobe and the AQ Flex™ probe could be inserted easily in parallel into the lesion in all cases. Overall, the agreement between the "tool-in-lesion" signal based on CLE images and the proof of malignancy was found to be 82%.

Conclusion: A transbronchial cryobiopsy under simultaneous pCLE guidance using an AQ Flex™ probe for peripheral pulmonary lesions is feasible and safe. Further studies are needed to evaluate the additional benefit of CLE imaging.

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: Excessive dynamic airway collapse (EDAC) is a condition characterized by excessive narrowing of the trachea and bronchi during exhalation, leading to respiratory symptoms. While bronchoscopic tracheobronchoplasty using laser-based thermal ablation has been reported in clinical practice, the lack of preclinical studies, including animal models, limits a comprehensive understanding of its safety and efficacy. This study compares laser and argon plasma coagulation (APC) thermal ablation in a Bama miniature pig model to assess their effects on airway histopathology and healing.

Methods: Twelve Bama miniature pigs underwent noncontact laser ablation and precise APC ablation of the membranous trachea via flexible bronchoscopy under different parameter settings. The animals were euthanized either immediately post-procedure or at 28 days. Histopathological changes were assessed using HE and Masson's trichrome staining. The remaining animals were closely monitored for 28 days postoperatively for infection, hemoptysis, and respiratory distress. Bronchoscopic evaluations were conducted on days 7, 14, 21, and 28 to assess tracheal healing.

Results: All 12 procedures were successfully completed without major intraoperative complications. Acute histopathological changes included necrosis and sloughing of the mucosal and submucosal layers. Between postoperative days 7 and 14, varying degrees of cough and dyspnea were observed. By day 28, histopathological analysis showed significant collagen fiber proliferation in the submucosal layer, with collagen layer thickness directly proportional to APC power and inversely proportional to laser power.

Conclusion: When the injury depth is limited to the submucosal layer of the tracheal membranous part by setting reasonable technical parameters, laser and precise APC can induce fibrous tissue hyperplasia and collagen deposition. However, precise APC is safer and more feasible, and further research is still needed to improve the surgical parameters and evaluate long-term clinical results.