Respiration最新文献

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.

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.

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: IAB-1 is the first-in-human study of the implantable artificial bronchus (IAB) in patients with severe emphysema. The IAB is a bronchoscopically delivered, self-expanding, tapered stent made of polyether ether ketone. By restoring the original airway and preventing expiratory collapse, it allows release of hyperinflated air. It is indifferent to collateral ventilation and disease distribution.

Methods: In a primary bronchoscopy, 1 or 2 IABs are implanted in the most diseased lobe. A secondary bronchoscopy at 30 days allows implantation of 1 or 2 additional IABs in another lobe. The primary endpoint, evaluated at 90 days, was safety, defined as any of 10 prespecified respiratory serious adverse device events (SADEs). Secondary endpoints included other related adverse events and multiple efficacy measures.

Results: Twenty patients were implanted with 53 IABs: 5 subjects formed the early termination set (ETS) because of SADEs; 15, the full analysis set (FAS), continued to the 90-day endpoint. All 5 ETS patients and 2 FAS patients experienced 4 of the 10 primary respiratory SADEs: pneumonia, airway injury, COPD exacerbation, and pneumothorax. The majority of patients improved clinically with statistically significant outcomes in all effectiveness variables (residual volume, six-minute walk distance, modified Medical Research Council, COPD Assessment Test, Saint George Respiratory Questionnaire, and EuroQual 5-Dimensional) with the exception of forced expiratory volume in 1 s.

Conclusion: IAB-1 demonstrated feasibility and a risk profile that improved during the trial by identifying and addressing the need for improved patient selection, implant site selection, implant technique, and delivery system improvements. The IAB may be desirable for emphysema patients who are ineligible for other interventional treatments and wish to avoid surgery.

Introduction: Body weight (BW) loss is common in interstitial lung disease (ILD) patients and correlated with poor prognosis. This study aimed to verify whether multidisciplinary interventions combining pulmonary rehabilitation and nutritional management affect BW loss and prognosis in ILD.

Methods: We retrospectively examined changes in body composition including BW in ILD patients who were admitted to our hospital for the comprehensive pulmonary rehabilitation program. These parameters were measured 6 months before, at the beginning, and 6 months after the program. We investigated the program's impact on BW loss and its association with survival.

Results: Of the 169 program participants, 40 ILD patients with tracked BW trends were enrolled. A significant BW loss was observed during 6 months before the program (p < 0.001); however, the intervention successfully halted further BW loss (p = 0.116). Patients on antifibrotic medications also showed similar BW trends. Notably, patients with pleuroparenchymal fibroelastosis showed a significant BW loss before the program (-1.8 kg, p < 0.001) but exhibited BW gain following the intervention (+1.0 kg, p = 0.475). Regarding the survival, BW loss halted group (effective group) had a significantly longer survival (log rank, p = 0.022). In multivariate analysis, BW loss >5% was identified as a prognostic indicator. This program successfully halted BW loss and increased survival.

Conclusion: Multidisciplinary rehabilitation effectively managed BW, leading to better survival in ILD. In particular, there is currently no treatment for pleuroparenchymal fibroelastosis, and multidisciplinary rehabilitation offers a promising treatment option.

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: 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.