Respiration最新文献

Background:  Airway fibrostenosis, a severe complication of tracheobronchial tuberculosis (TBTB), causes respiratory morbidity including atelectasis, pneumonia, and respiratory failure. Early risk prediction remains challenging due to the lack of validated assessment tools.

Methods:  This retrospective cohort study analyzed TBTB patients undergoing bronchoscopic interventions between January 2021 and June 2024 with 6-month follow-up. A Cox regression model was developed in all 305 patients, internally validated with 1,000 bootstrap resamples. Performance was evaluated via C-index, ROC-AUC, calibration, and decision curve analysis. Kaplan-Meier analysis was used to stratify groups, with log-rank tests assessing differences.

Results:  Airway fibrostenosis incidence was 60.33% (184/305). Eight independent predictors were identified: symptom duration, affected lung lobes, diabetes, multiple TBTB types, bronchoscopic intervention frequency, initial sputum acid-fast bacilli smear grade, neutrophil-to-lymphocyte ratio, and CD8+ T-cell count. The nomogram demonstrated strong discrimination (C-index 0.77, 95%CI 0.75-0.81) with increasing predictive accuracy over time: 6-week AUC 0.773 (0.708-0.838), 8-week 0.792 (0.740-0.844), 12-week 0.830 (0.782-0.878), and 16-week 0.883 (0.842-0.923). High-risk patients exhibited a significantly higher probability of developing airway fibrostenosis compared to low-risk patients (P<0.001). Calibration and decision curve analyses confirmed clinical utility.

Conclusions:  This validated nomogram effectively predicts airway fibrostenosis risk in TBTB patients, enabling early identification of high-risk individuals for targeted interventions.

The german guideline on non-invasive ventilation offers comprehensive recommendations for the treatment of chronic respiratory failure in various underlying conditions, such as COPD, thoraco-restrictive diseases, obesity-hypoventilation syndrome, and neuromuscular diseases. The aim of the guideline is to improve the treatment of patients with chronic respiratory insufficiency using non-invasive ventilation and to make the indications and therapy recommendations accessible to all involved in the treatment process. It is based on the latest scientific evidence and replaces the previous guideline from 2017. This revised guideline provides detailed recommendations on the application of non-invasive ventilation, ventilation settings, and the subsequent follow-up of treatment. In addition to the updated evidence, important new features of this guideline include new recommendations on patient care and numerous detailed treatment pathways that make the guideline more user-friendly. Furthermore, a completely revised section is dedicated to ethical issues and offers recommendations for end-of-life care. This guideline is an important tool for physicians and other healthcare professionals to optimize the care of patients with chronic respiratory failure.

Introduction: Training-induced adaptations of the oxidative capacity have been shown to be blunted in alpha-1 antitrypsin deficiency (AATD)-related chronic obstructive pulmonary disease (COPD). To improve training outcomes in AATD, this study was aimed to compare the effects of two exercise training programmes with different training intensities.

Methods: Thirty patients with AATD (genotype PiZZ) and COPD III-IV were randomly assigned to either high-intensity (HIT) or moderate-intensity training (MIT), each consisting of endurance, strength, and squat training for a duration of 3 weeks. 6-Min walk distance (6MWD) was used as the primary outcome.

Results: Twenty-five subjects augmented with alpha-1 antitrypsin (HIT: n = 12, FEV1 41.3 ± 17.4%pred., MIT: n = 13, FEV1 45.9 ± 15.5%pred.) completed the study. In HIT and MIT, 6MWD (+37 ± 43 m vs. +32 ± 28 m, p = 0.741), 1-min sit-to-stand test (5.6 ± 4.9 repetitions vs. 5.6 ± 4.5 repetitions, p = 0.766), exercise-induced BORG dyspnoea (-1.4 ± 1.7 pts vs. -1.5 ± 2.4 pts, p = 0.952), and all CRQ domains have improved after training without between-group differences. When considering only subgroups of (probably) anxious or depressive patients (Hospital Anxiety and Depression Scale [HADS] ≥8 pts), only HIT induced a significant reduction of anxiety (-4.8 pts, 95% CI [2.1-7.5]) or depression symptoms (-5.0 pts, 95% CI [2.8-7.3]).

Conclusion: Although HIT and MIT were equally effective by improving exercise capacity, quality of life, and dyspnoea in homozygous AATD, HIT may show advantages over MIT, if anxiety or depression symptoms were present. The goal should be personalized training based on the patient's personal preference in order to achieve long-term adherence.

Introduction: Cone beam computed tomography-guided navigation bronchoscopy (CBCT-NB) with augmented fluoroscopy (AF) guidance represents a minimally invasive endobronchial technique for diagnosing small, peripheral pulmonary lesions. This approach is characterized by its high diagnostic accuracy and low complication risk. Current pilot trials are exploring the application of localized therapies using this innovative approach. This report aims to provide a detailed procedural guide for performing CBCT-NB with AF guidance as the only tool for navigation and image guided biopsy.

Methods: We outline the procedural steps involved in the CBCT-NB procedure for diagnosing peripheral pulmonary lesions, supported by specific intra-procedural clinical video footage. The steps include (1) preprocedural considerations, (2) a detailed procedural workflow encompassing navigation to the target lesion, (3) position confirmation and tissue acquisition, and (4) postprocedural follow-up.

Conclusion: CBCT-NB with AF guidance is a safe and precise stand-alone navigation modality that offers high-resolution real-time 3D imaging, enhancing the diagnosis and potential treatment of peripheral pulmonary nodules.

Introduction: Cone beam computed tomography-guided navigation bronchoscopy (CBCT-NB) with augmented fluoroscopy (AF) guidance represents a minimally invasive endobronchial technique for diagnosing small, peripheral pulmonary lesions. This approach is characterized by its high diagnostic accuracy and low complication risk. Current pilot trials are exploring the application of localized therapies using this innovative approach. This report aims to provide a detailed procedural guide for performing CBCT-NB with AF guidance as the only tool for navigation and image guided biopsy.

Methods: We outline the procedural steps involved in the CBCT-NB procedure for diagnosing peripheral pulmonary lesions, supported by specific intra-procedural clinical video footage. The steps include (1) preprocedural considerations, (2) a detailed procedural workflow encompassing navigation to the target lesion, (3) position confirmation and tissue acquisition, and (4) postprocedural follow-up.

Conclusion: CBCT-NB with AF guidance is a safe and precise stand-alone navigation modality that offers high-resolution real-time 3D imaging, enhancing the diagnosis and potential treatment of peripheral pulmonary nodules.

Introduction: Endoscopic lung volume reduction (ELVR) with valves is an effective intervention in patients with severe lung emphysema. Two types of valves are established in clinical practice: Zephyr endobronchial valves (EBVs) and Spiration Valve System (SVS). We aimed to compare outcomes and the safety associated with these two types of one-way valves.

Methods: Data were collected from three German lung emphysema centers as part of a prospective observational study focusing on lung volume reduction. Two groups were formed based on valve types. In both groups, lung function (FEV1, RV, diffusion capacity of the lung for carbon monoxide, pCO2), 6-min walking distance (6MWD), quality of life (SGRQ, mMRC, CAT), and complication rate were recorded at baseline and at follow-up 3 to 6 months later.

Results: A total of 54 patients were treated with SVS valves and 99 patients with EBV. There were no significant differences between both groups at baseline. Notably, both types of valves exhibited significant enhancements in lung function and quality of life. Interestingly, there were no significant differences in the median change of all measured parameters for both groups, suggesting comparable improvements in EBV and SVS. Pneumothorax was the most common complication for both valve types. The incidence of adverse events did not differ significantly between groups.

Conclusion: Our study suggests that both types of valves are safe and effective in the treatment of severe lung emphysema. We recommend choosing the valve type based on individual bronchial anatomy. However, further randomized studies are needed to confirm our results.

Introduction: Post-tracheostomy tracheal stenosis is a clinically relevant late complication of tracheostomy. To date, there is no standardized treatment strategy for post-tracheostomy tracheal stenosis. Contact cryoablation is one of the applicable methods. The aim of the present study was to explore the efficacy and safety of contact cryoablation for the treatment of post-tracheostomy tracheal stenosis.

Methods: A total of 63 consecutive patients were included in this unicentre, combined retrospective and prospective observational study in an intensive care unit of a German neurological specialist hospital from 30 April 2020 to 21 March 2024. Post-tracheostomy tracheal stenoses were confirmed by tracheoscopy. All eligible patients were primarily treated with contact cryoablation. Primary endpoint was the rate of successful removal of the tracheostomy tube (decannulation) until hospital discharge. Technical success was defined as the absence of an endoscopically relevant residual post-tracheostomy tracheal stenosis, and clinical success was defined as the absence of symptoms, e.g., dyspnoea and stridor, both at discretion of the endoscopist and treating physician.

Results: A total of 78 interventions were performed (median: 1 per patient). Cryoablation was applied in 67% of patients at least once. A total of 70% of patients could be decannulated after treatment. Technical success and clinical success were achieved in 88% and 70% of patients, and in only 5% of patients surgical treatment was performed. No complications were observed.

Conclusion: Contact cryoablation appears to be an effective, complication-free, simple, and non-surgical treatment option for patients with post-tracheostomy tracheal stenosis. It could be an excellent option for every patient with suitable stenosis morphology. However, other endoscopic modalities must be available or complementarily used for non-suitable stenosis morphologies.

Introduction: Balloon pulmonary angioplasty (BPA) is an effective intervention for patients with chronic thromboembolic pulmonary disease (CTEPD). We aimed to identify the patient group with a low success rate or high complication rate of BPA, which is still unclear.

Methods: Both CTEPD patients with or without pulmonary hypertension (CTEPH and NoPH-CTEPD) were included. CTEPH patients were divided into groups with or without pulmonary endarterectomy (PEA-CTEPH and NoPEA-CTEPH). The efficacy and safety of BPA were compared among the groups.

Results: There were 450, 66, and 41 sessions in the NoPEA-CTEPH, PEA-CTEPH, and NoPH-CTEPD groups, respectively. The success rate (≥1 degree improvement in flow grade) in the PEA-CTEPH group was 94.5%, significantly lower than that in the NoPEA-CTEPH (97.1%) and NoPH-CTEPD (98.4%) groups (p = 0.014). The percentage of complete flow recovery in treated vessels was also lower in PEA-CTEPH group. BPA-related complication rate in NoPEA-CTEPH, PEA-CTEPH, and NoPH-CTEPD patients was 6.1%, 6.0%, and 0.0%, respectively (p = 0.309). One BPA-related death occurred (solely in NoPEA-CTEPH). Mean pulmonary artery pressure ≥41.5 mm Hg was a predictor of BPA-related complications. NoPEA-CTEPH patients had more improvement in 6-min walk distance (6MWD, 87 ± 93 m NoPEA-CTEPH vs. 40 ± 43 m PEA-CTEPH vs. 18 ± 20 m NoPH-CTEPD, p = 0.012).

Conclusions: BPA was safe and effective for all CTEPD groups with less improvement for the PEA-CTEPH and NoPH-CTEPD groups. The success rate of BPA was lower in the PEA-CTEPH group and the complication rate was lower in the NoPH-CTEPD group. Pre-BPA treatment to lower pulmonary artery pressure should not be overlooked in CTEPD patients.

Introduction: Idiopathic pulmonary fibrosis (IPF) is a chronic progressive disease that subverts the normal structure of the lungs and finally causes respiratory failure. High-flow nasal therapy (HFNT) is currently used in the acute setting for IPF with acute respiratory failure. Also, acute exacerbation of IPF and end-stage disease are common indications. Chronic cough is often an unmet need in IPF because it is partially responsive to common pharmacological treatment. Moreover, opioids have known adverse events. The aim of this paper was to investigate the effects and safety of chronic HFNT on lung function and symptoms of IPF.

Methods: This is a single-center case-control study including patients affected by IPF. We included 35 adult patients with a consistent radiological diagnosis of IPF, clinical history of lung function decline, and high prevalence of symptoms. All patients received the standard of treatment, particularly including antifibrotic drugs and conventional oxygen therapy (COT). Eighteen subjects were assigned to additional treatment with HFNT for 12 months.

Results: No significant differences were observed after the follow-up with HFNT in terms of lung function. The mean forced vital capacity (FVC) was 1.89 ± 0.73 L with HFNT and 2.43 ± 0.87 L without HFNT (p = 0.09). The mean FVC decline per year was 190 mL with HFNT versus 200 mL with standard of care. The mean DLCO % of predicted was 28.86 ± 14.51% with HFNT and 36.03 ± 19.18% with COT (p = 0.276). No significant impact was observed on dyspnea; the mean Borg scale value was 6.72 ± 2.22 after HFNT and 7.14 with COT (p = 0.56). The score for cough significantly improved after treatment with a mean score in the HFNT group being 46.67 ± 10.85 versus 73.8 ± 18.43 (p < 0.0001) with standard of care.

Conclusions: Long-term HFNT significantly reduces chronic cough in patients affected by IPF compared to COT. Lung function including FVC and DLCO is not significatively influenced.

Introduction: Pulmonary exacerbations increase the requirement of aminoglycoside (AG) antibiotics in people with cystic fibrosis (pwCF). Several studies have shown that AGs have a cumulative effect on ototoxicity. We aimed to investigate the relationship between AG exposure and ototoxicity by using 3 different methods in patients with CF.

Materials/methods: The multicenter study included 121 pwCF aged between 5 and 18 years with a history of parenteral AG exposure. Standard pure-tone audiometry, extended high-frequency pure-tone audiometry (EHF-PTA), and distortion-product otoacoustic emissions (DPOAE) tests were performed. Mitochondrial mutation analysis for m1555G>A was performed in 61 patients.

Results: Median age was 12.85 years and 52.1% (n = 63) were male. 18.2% (n = 22) of the patients had received parenteral AGs more than 5 courses/lifetime. Ototoxicity was detected in at least one of the tests in 56.2% (n = 68) of the patients. Only 10.7% (n = 13) of the patients had reported a symptom indicating ototoxicity. 30.3% (n = 30) of the patients had ototoxicity in the low exposure group, while it was 45.5% (n = 10) in the high exposure group according to EHF-PTA (p > 0.05). Median number of parenteral amikacin courses was significantly higher in the ototoxic group (2 [1.25-5.75] vs. 2 [1-3]; p = 0.045). No m1555A>G mutation was detected in 61 patients who screened for mitochondrial mutation analysis.

Conclusion: As AG ototoxicity occurs primarily at high frequencies, EHF-PTA is important in early detecting ototoxicity. EHF-PTA and DPOAE detected ototoxicity in some patients with normal PTA results. All pwCF with a history of AG exposure should be evaluated for hearing loss since symptoms may only be noticed in the late period.

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.