Respiration最新文献

Introduction: This study aimed to evaluate both the clinical efficacy and safety of airway stent placement in the treatment of patients with esophageal cancer-associated airway esophageal fistula (AEF). The focus is on evaluating improvements in patient survival and quality of life.

Methods: Overall, this study enrolled 111 patients diagnosed with esophageal cancer-associated AEF. Among them, 50 (45.0%) and 61 (55.0%) patients received airway stent placement and conservative treatment, respectively. Follow-up assessments were conducted to determine the clinical efficacy and safety of the interventions, with survival and quality of life as the primary endpoints.

Results: By the end of the follow-up, 98 of 111 patients (88.3%) had died, leaving 13 survivors (11.7%). Patients with esophageal cancer-associated AEF had an overall mean survival time of 147.4 (95% CI, 123.9-170.9) days. Patients in the stent placement group had a mean survival of 192.5 (95% CI, 151.2-233.7) days, which was significantly longer than the 110.0 (95% CI, 88.1-131.8) days in the conservative treatment group (p < 0.001). Sex (p = 0.017), tumor stage (p = 0.030), surgery (p = 0.005), pulmonary infection (p < 0.001), fistula size (p < 0.001), and pre-Karnofsky Performance Status (KPS) (p < 0.001) were the independent risk factors affecting survival. Furthermore, patients in the stent placement group demonstrated improved KPS scores post-treatment, increasing from 48.2 to 57.9 (p = 0.017).

Conclusion: Airway stent placement is beneficial in alleviating the symptoms, quality of life, and survival of patients with esophageal cancer-associated AEF.

Introduction: Rapid On-Site Evaluation (ROSE) entails immediate pathological evaluation of diagnostic specimens in the procedure room, facilitating real-time feedback to operator on specimen adequacy and diagnosis. There is ongoing debate about its role in the field of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration.

Methods: To re-evaluate the impact of ROSE, we completed a retrospective cohort analysis of prospectively maintained Greater Manchester EBUS database encompassing all linear EBUS procedures between 1 January 2017 and 31 December 2018 at the ROSE centre versus all linear EBUS procedures in the same period at a non-ROSE centre. Diagnostic performance plus procedural factors such as lymph node (LN) stations sampled and sedation doses were examined and then stratified according to EBUS indication.

Results: In total, 1,650 consecutive EBUS procedures were examined across two centres. Using ROSE resulted in statistically significant reduction in number of nodes sampled, time to pathology, and sedation doses for most indications. In 697 staging EBUS, sensitivity at the ROSE centre was 95% (95% CI 91-97%), negative predictive value (NPV) 93% (95% CI 88-96%) with prevalence of mediastinal nodal metastases of 27% (103/376) versus non-ROSE sensitivity 85% (95% CI 79-90%), NPV 86% (95% CI 80-90%) with prevalence of mediastinal nodal metastases of 32% (103/321). In 329 diagnostic EBUS, using ROSE resulted in a statistically significant reduction in number of LN stations sampled per procedure (median 1 station [1-1] with ROSE vs. 2 [1-2], p < 0.001). Diagnostic performance was higher at the ROSE centre including increases in sensitivity of 7% for diagnostic EBUS in advanced lung cancer, 20% for isolated mediastinal/hilar lymphadenopathy, and 17% for diagnosis of nodal metastases from extra-thoracic malignancy.

Conclusion: This study suggests ROSE may provide additional value in diagnostic performance in EBUS and warrants further discussion in an evolving lung cancer and bronchoscopic landscape.

Introduction: Hematological conditions, mainly allogeneic hematopoietic cell transplantation (allo-HCT) and chronic lymphocytic leukemia (CLL), have known associations with bronchiectasis. However, data on these unique clinical entities remain limited. We aimed to evaluate the clinical characteristics and outcomes of patients with hematology-related bronchiectasis.

Methods: This retrospective study included patients with bronchiectasis following allo-HCT and CLL. Groups were matched and compared to a control group of bronchiectasis from non-hematological conditions (n = 126). Clinical variables, radiologic features, and disease outcomes were analyzed.

Results: Overall, 42 patients with bronchiectasis after allo-HCT (median age 59, 36% female) and 63 patients with bronchiectasis and CLL (median age 72, 40% female) were included. Both groups exhibited worse lung functions compared to the control. They had more isolations of Pseudomonas aeruginosa (PA) compared to the control group (21-31% vs. 9%) and less non-tuberculosis mycobacteria (3-5% vs. 21%). Allo-HCT and CLL patients also showed high rates of diffuse bronchiectasis distribution (38% and 40%), hypogammaglobulinemia (41% and 71%), and 1-year respiratory hospitalizations (50% and 54%). Only 26% of allo-HCT and 35% of CLL patients saw a pulmonologist, and only 14% performed routine airway clearance. Mortality was higher in both groups compared to controls. The key variables associated with mortality were bronchiolitis obliterans syndrome in the allo-HCT group (HR 11.1, 95% CI: 2.9-30.6) and PA isolation in the CLL group (HR 2.96, 95% CI: 1.3-6.8).

Conclusion: Hematology-related BE have distinct clinical and radiologic features with associated morbidity. These findings could help identify at-risk subgroups for early pulmonologist referral.

Background: Established structured weaning approaches, which are effective for patients in simple and difficult weaning, are often not appropriate for patients undergoing prolonged weaning. Addressing the complexity of weaning failure requires personalized precision medicine. The therapeutic concept of treatable traits (TTs) has been proposed as a new paradigm for the management of chronic respiratory diseases. It is based on a multidimensional assessment of specific characteristics, which can be addressed by specific interventions that go beyond traditional diagnostic criteria. The concept is increasingly adopted for other complex diseases.

Summary: This is a narrative review and an expert opinion on the development of a concept of TTs for patients undergoing prolonged weaning. The proposed TTs are based on a systematic review of risk factors for prolonged weaning, an analysis of claims data to assess risk factors within 96 h of IMV onset and data from the WEAN SAFE study. A multidisciplinary team identified clinically important TTs and determined appropriate interventions. The following TTs have been identified: airway disorders and complications associated with tracheostomy or intubation, such as airway obstruction, strictures or tracheomalacia, infectious aspects, anxiety, depression, delirium, post-traumatic stress disorder, anemia, pulmonary and cardio-renal disease. The multidimensional holistic approach also includes tailored sedation and pain management, nutritional therapy, early mobilization, and physiotherapy.

Key message: We propose a framework of relevant considerations for a multidimensional approach to the management of patients undergoing prolonged weaning that supports the regain of respiratory capacity, reduces the respiratory load, and thus could resolve the respiratory workload imbalance.

Introduction: Survivors of severe COVID-19 face complex challenges and a high degree of pulmonary sequelae. Therefore, we aim to describe their ongoing health burden.

Methods: In this single-center prospective cohort study, COVID-19 ICU survivors were invited 3 and 6 months after ICU discharge. We examined pulmonary function with pulmonary function tests (PFT) and cardiopulmonary exercise testing (CPET), and we established health-related quality of life (HRQL) and health status (HS) with the EuroQol five-dimension five-level (EQ-5D-5L), the short-form health survey 12 (SF-12), and the modified British Medical Research Council dyspnea scale (mMRC) questionnaires.

Results: Out of the 53 individuals screened, 23 participated in this study. Throughout both assessment points, participants maintained PFT results within range, apart from a decline in the transfer factor of the lung for carbon monoxide (TLCO). CPET showed improved fitness but persistent ventilatory deficiencies, indicated by altered dead space ventilation (VD/VT) and elevated arterial-alveoli gradient for oxygen (AaDO2). HRQL and HS remained compromised, with both physical (PCS) and mental component summary (MCS) scores significantly lower than the standardized norm population scores. Also, there was a rise in the prevalence of issues related to mobility, pain/discomfort, and anxiety/depression, and an increase in reported dyspnea.

Conclusion: These results enhance our comprehension of the complex difficulties faced by COVID-19 ICU survivors. Six months post-discharge, CPET revealed the presence of ventilatory insufficiencies. Additionally, there was a decline in HRQL and HS, notably affected by mental health concerns and an increase in the level of dyspnea.

Introduction: Currently, there is a lack of bronchoscopic lung volume reduction options that do not depend on fissure integrity. Endobronchial coils have been extensively studied to address this need but exhibited variable patient response and have been discontinued. Lung tension device (LTD) coils represent the next-generation coil treatment. This study aimed to evaluate safety, feasibility, and efficacy of LTD-coil treatment.

Methods: Patients with advanced emphysema and hyperinflation were enrolled at two European sites. LTD-coils (Free Flow Medical, Fremont, CA, USA) were implanted in the two most destructed lobes, as determined by quantitative CT analysis, in two separate procedures. The primary endpoint was 3-month follow-up after the last treatment.

Results: Fourteen patients (50% male, median age 64 years, FEV1 23%predicted, RV 249%predicted) received LTD-coil treatment: 12 received bilateral and 2 unilateral treatment. Six serious respiratory adverse events occurred within the initial 3 months posttreatment, including one device-associated death. Treatment significantly reduced in- and expiratory volume of the treated lobes (-410 [-710, -340], p = 0.004 and -650 [-730, -190] mL, p < 0.001, respectively) and improved quality of life (SGRQ total score -4.6 [-21.0, -2.6], p < 0.001). However, at a group level, no significant improvements in pulmonary function or 6-min walk distance were observed. Responder rates ranged from 18% to 54% for the different endpoints.

Conclusion: This first-in-human study shows that the new LTD-coil procedure is feasible with a safety profile comparable to the previous coil treatment. While the treatment effectively reduced lobar volume and modestly improved quality of life up to 3 months' follow-up, at a group level it did not significantly enhance pulmonary function or exercise capacity.

Introduction: Elexacaftor/tezacaftor/ivacaftor (ETI) has shown significant improvements in pulmonary and nutritional status in persons with cystic fibrosis (pwCF). Less is known about the extrapulmonary impact of ETI and effects on airway microbiology, lung clearance index (LCI), and fraction of exhaled nitric oxide (FeNO).

Methods: This is a multicenter prospective observational trial, including 79 pwCF ≥18 years eligible for ETI. Assessments were done at the initiation of and 3 and 6 months into treatment with ETI. Outcomes included forced expiratory volume in 1 s (FEV1), LCI, FeNO, sputum or cough swab culture, body mass index (BMI), cystic fibrosis questionnaire-revised respiratory domain (CFQ-R RD), sinonasal outcome test-22 (SNOT-22), general anxiety disorder-7 (GAD-7), patient health questionnaire-9 (PHQ-9), fecal elastase-1 (FE-1), adherence to baseline therapies, exacerbation rate, and adverse events.

Results: Our cohort included 79 pwCF (31 ± 11(SD) years) with a baseline ppFEV1 of 68 ± 23. Forty-two (53%) pwCF were previously treated with a CFTR modulator. In the entire study group, there were significant improvements from baseline in ppFEV1, LCI, FeNO, annualized exacerbation rate, BMI, CFQ-R RD, and SNOT-22 (p < 0.05 for all). Airway culture positivity for methicillin-susceptible Staphylococcus aureus and Pseudomonas aeruginosa also decreased during the study period. There was no significant change in FE-1, GAD-7, or PHQ-9. Adherence to dornase alfa and hypertonic saline decreased.

Conclusion: ETI treatment led to significant improvements in respiratory and nutritional status, alongside a decrease in adherence to chronic supportive therapies. We did not observe any significant changes in exocrine pancreas function or in questionnaire scores for depression and anxiety.