Pub Date : 2022-08-01Epub Date: 2022-06-24DOI: 10.1016/S2213-2600(22)00223-5
Vasilios Tzilas, Argyrios Tzouvelekis, Jay H Ryu, Demosthenes Bouros
{"title":"2022 update on clinical practice guidelines for idiopathic pulmonary fibrosis and progressive pulmonary fibrosis.","authors":"Vasilios Tzilas, Argyrios Tzouvelekis, Jay H Ryu, Demosthenes Bouros","doi":"10.1016/S2213-2600(22)00223-5","DOIUrl":"https://doi.org/10.1016/S2213-2600(22)00223-5","url":null,"abstract":"","PeriodicalId":326030,"journal":{"name":"The Lancet. Respiratory medicine","volume":" ","pages":"729-731"},"PeriodicalIF":76.2,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40405045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01Epub Date: 2022-03-21DOI: 10.1016/S2213-2600(22)00096-0
Rémi Coudroy, Jean-Pierre Frat, Stephan Ehrmann, Frédéric Pène, Maxens Decavèle, Nicolas Terzi, Gwenaël Prat, Charlotte Garret, Damien Contou, Arnaud Gacouin, Jeremy Bourenne, Christophe Girault, Christophe Vinsonneau, Jean Dellamonica, Guylaine Labro, Sébastien Jochmans, Alexandre Herbland, Jean-Pierre Quenot, Jérôme Devaquet, Dalila Benzekri, Emmanuel Vivier, Saad Nseir, Gwenhaël Colin, Didier Thevenin, Giacomo Grasselli, David Bougon, Mona Assefi, Claude Guérin, Thierry Lherm, Achille Kouatchet, Stephanie Ragot, Arnaud W Thille
Background: Although non-invasive ventilation (NIV) is recommended for immunocompromised patients with acute respiratory failure in the intensive care unit (ICU), it might have deleterious effects in the most severe patients. High-flow nasal oxygen (HFNO) alone might be an alternative method to reduce mortality. We aimed to determine whether HFNO alone could reduce the rate of mortality at day 28 compared with HFNO alternated with NIV.
Methods: FLORALI-IM is a multicentre, open-label, randomised clinical trial conducted in 29 ICUs (28 in France and one in Italy). Adult immunocompromised patients with acute respiratory failure, defined as respiratory rate of 25 breaths per min or more and a partial pressure of arterial oxygen to inspired fraction of oxygen ratio of 300 mm Hg or lower, were randomly assigned (1:1) to HFNO alone (HFNO alone group) or NIV alternating with HFNO (NIV group). Key exclusion criteria were severe hypercapnia above 50 mm Hg, patients who could strongly benefit from NIV (ie, those with underlying chronic lung disease, with cardiogenic pulmonary oedema, or who were postoperative), severe shock, impaired consciousness defined as Glasgow coma score ≤12, urgent need for intubation, do not intubate order, and contraindication to NIV. Patients were assigned using computer-generated permuted blocks and were stratified according to centre and to the type of immunosuppression using a centralised web-based management system. In the HFNO alone group, patients were continuously treated by HFNO with a gas flow rate of 60 L/min or the highest tolerated. In the NIV group, patients were treated with NIV with a first session of at least 4 h, and then by sessions for a minimal duration of 12 h a day, with a dedicated ventilator, targeting a tidal volume below 8 mL/kg of predicted bodyweight, and with a positive end-expiratory level of at least 8 cm H2O. NIV sessions were interspaced with HFNO delivered as in the HFNO alone group. The primary outcome was mortality at day 28 and was assessed in the intention-to-treat population. Secondary outcomes were mortality in the ICU, in hospital, at day 90 and at day 180, intubation at day 28, length of stay in the ICU and in hospital, number of ventilator-free days at day 28, number of oxygenation technique-free days at day 28, and efficacy and tolerance of oxygenation techniques. The trial is registered with ClinicalTrials.gov, NCT02978300, and is complete.
Findings: Between Jan 21, 2017 to March 4, 2019, of 497 eligible patients, 300 were randomly assigned but one patient withdrew consent, leaving 299 patients included in the intention-to-treat analysis (154 assigned to the HFNO alone group and 145 assigned to NIV group). Mortality rate at day 28 was 36% (95% CI 29·2 to 44·2; 56 of 154 patients) in the HFNO alone group and 35% (27·9 to 43·2; 51 of 145 patients) in the NIV group (absolute difference 1·2% [95% CI -9·6 to 11·9];
背景:虽然无创通气(NIV)被推荐用于重症监护病房(ICU)免疫功能低下的急性呼吸衰竭患者，但它可能对最严重的患者产生有害影响。单纯高流量鼻吸氧可能是降低死亡率的另一种方法。我们的目的是确定与HFNO与NIV交替使用相比，单独使用HFNO是否可以降低第28天的死亡率。方法:FLORALI-IM是一项多中心、开放标签、随机临床试验，在29个icu中进行(法国28个，意大利1个)。急性呼吸衰竭的成人免疫功能低下患者，定义为呼吸频率为每分钟25次或以上，动脉氧分压与吸入氧分数之比为300 mm Hg或更低，随机(1:1)分配到HFNO单独组(HFNO单独组)或NIV与HFNO交替组(NIV组)。关键的排除标准是严重高碳酸血症高于50毫米汞柱，可能从NIV中获益的患者(即伴有潜在慢性肺病，心源性肺水肿或术后患者)，严重休克，格拉斯哥昏迷评分≤12定义的意识受损，迫切需要插管，不插管顺序，NIV禁忌症。使用计算机生成的排列块对患者进行分配，并使用基于web的集中管理系统根据中心和免疫抑制类型进行分层。单用HFNO组，以60l /min或最高耐受量持续使用HFNO治疗。在NIV组中，患者接受NIV治疗，第一次治疗至少4小时，然后每天至少持续12小时，使用专用呼吸机，目标潮气量低于8 mL/kg预测体重，呼气末阳性水平至少为8 cm H2O。与单独使用高鼻血一氧化氮组一样，NIV疗程与高鼻血一氧化氮组间隔进行。主要终点是第28天的死亡率，并在意向治疗人群中进行评估。次要结局为ICU死亡率、住院死亡率、第90天和第180天死亡率、第28天插管率、在ICU和住院时间、第28天无呼吸机天数、第28天无氧合技术天数、氧合技术的疗效和耐受性。该试验已在ClinicalTrials.gov注册，编号NCT02978300，目前已完成。在2017年1月21日至2019年3月4日期间，497名符合条件的患者中，300名患者被随机分配，但1名患者撤回了同意，剩下299名患者被纳入意向治疗分析(154名患者被分配到HFNO单独组，145名患者被分配到NIV组)。第28天死亡率为36% (95% CI 29.2 ~ 44.2;154例患者中56例为单纯HFNO组，35% (27.9 ~ 43.2;145例患者中有51例)(绝对差值为1.2% [95% CI - 9.6 ~ 11.9];p = 0·83)。其他预定的次要结果在两组之间没有差异，除了HFNO开始后的不适减轻程度大于NIV(视觉类比量表- 4mm [IQR -18至4]vs 0 mm[-16至17]);p = 0·040)。结论:在急性呼吸衰竭的危重免疫功能低下患者中，单纯使用高氧一氧化氮和NIV交替使用高氧一氧化氮的死亡率没有差异。然而，研究力量有限，因此结果应谨慎解释。资助:法国卫生部。
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Pub Date : 2022-06-01DOI: 10.1016/S2213-2600(22)00211-9
D. Munblit, D. Buonsenso, L. Sigfrid, S. Vijverberg, C. Brackel
{"title":"Post-COVID-19 condition in children: a COS is urgently needed","authors":"D. Munblit, D. Buonsenso, L. Sigfrid, S. Vijverberg, C. Brackel","doi":"10.1016/S2213-2600(22)00211-9","DOIUrl":"https://doi.org/10.1016/S2213-2600(22)00211-9","url":null,"abstract":"","PeriodicalId":326030,"journal":{"name":"The Lancet. Respiratory medicine","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114337414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1016/s2213-2600(22)00165-5
S. Stick, Alexia Foti, R. Ware, H. Tiddens, B. Clements, D. Armstrong, H. Selvadurai, A. Tai, P. Cooper, C. Byrnes, Y. Belessis, C. Wainwright, A. Jaffe, P. Robinson, L. Saiman, P. Sly
{"title":"The effect of azithromycin on structural lung disease in infants with cystic fibrosis (COMBAT CF): a phase 3, randomised, double-blind, placebo-controlled clinical trial.","authors":"S. Stick, Alexia Foti, R. Ware, H. Tiddens, B. Clements, D. Armstrong, H. Selvadurai, A. Tai, P. Cooper, C. Byrnes, Y. Belessis, C. Wainwright, A. Jaffe, P. Robinson, L. Saiman, P. Sly","doi":"10.1016/s2213-2600(22)00165-5","DOIUrl":"https://doi.org/10.1016/s2213-2600(22)00165-5","url":null,"abstract":"","PeriodicalId":326030,"journal":{"name":"The Lancet. Respiratory medicine","volume":"25 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132090208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1016/S2213-2600(22)00180-1
H. Montgomery, F. Hobbs, F. Padilla, Douglas Arbetter, A. Templeton, S. Seegobin, Kenneth Kim, Jesus Abraham Simón Campos, R. Arends, Bryan H Brodek, Dennis Brooks, Pedro Garbes, J. Jiménez, G. Koh, Kelly W Padilla, K. Streicher, R. Viani, V. Alagappan, M. Pangalos, M. Esser, Wakana Tania Daria Daniel Kevin Carolina Ayoade Elena Jor Abe Adan De Varona Adiatullina Aguilar Zapata Ahle, Wakana Abe, Tania Adan De Varona, Daria Adiatullina, Daniel Aguilar Zapata, Kevin M Ahlers, C. Aimo, Ayoade Akere, E. Akimova, J. Alatorre Alexander, Logan Aldrich, I. Ali García, Karim Ali García, Lee Allison, R. Alonso Zúñiga, Ivan Aloysius, J. Altclas, A. Alvarisqueta, M. Antila, Camila Anton, Elisabet Árboix Alamo, S. Arora, Ramón Alejandro Avilés Felix, Natalya Bakhtina, V. Barbero-Becerra, Armando Barragán-Reyes, Alejandro Barreira, M. Barrett, J. Beran, Nikolett Berki, Viktoria Berki, R. Betten, C. Binelli, Lenka Brunzová, Cecilia Bussolari, Karianna Byargeon, Justyna Bytnar, C. Camberos, Pedro Campos Corzo, Grazia Can
{"title":"Efficacy and safety of intramuscular administration of tixagevimab–cilgavimab for early outpatient treatment of COVID-19 (TACKLE): a phase 3, randomised, double-blind, placebo-controlled trial","authors":"H. Montgomery, F. Hobbs, F. Padilla, Douglas Arbetter, A. Templeton, S. Seegobin, Kenneth Kim, Jesus Abraham Simón Campos, R. Arends, Bryan H Brodek, Dennis Brooks, Pedro Garbes, J. Jiménez, G. Koh, Kelly W Padilla, K. Streicher, R. Viani, V. Alagappan, M. Pangalos, M. Esser, Wakana Tania Daria Daniel Kevin Carolina Ayoade Elena Jor Abe Adan De Varona Adiatullina Aguilar Zapata Ahle, Wakana Abe, Tania Adan De Varona, Daria Adiatullina, Daniel Aguilar Zapata, Kevin M Ahlers, C. Aimo, Ayoade Akere, E. Akimova, J. Alatorre Alexander, Logan Aldrich, I. Ali García, Karim Ali García, Lee Allison, R. Alonso Zúñiga, Ivan Aloysius, J. Altclas, A. Alvarisqueta, M. Antila, Camila Anton, Elisabet Árboix Alamo, S. Arora, Ramón Alejandro Avilés Felix, Natalya Bakhtina, V. Barbero-Becerra, Armando Barragán-Reyes, Alejandro Barreira, M. Barrett, J. Beran, Nikolett Berki, Viktoria Berki, R. Betten, C. Binelli, Lenka Brunzová, Cecilia Bussolari, Karianna Byargeon, Justyna Bytnar, C. Camberos, Pedro Campos Corzo, Grazia Can","doi":"10.1016/S2213-2600(22)00180-1","DOIUrl":"https://doi.org/10.1016/S2213-2600(22)00180-1","url":null,"abstract":"","PeriodicalId":326030,"journal":{"name":"The Lancet. Respiratory medicine","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126614952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1016/s2213-2600(22)00134-5
B. Knox-Brown, Andreia F Amaral, Peter M Burney
{"title":"Concerns about PRISm.","authors":"B. Knox-Brown, Andreia F Amaral, Peter M Burney","doi":"10.1016/s2213-2600(22)00134-5","DOIUrl":"https://doi.org/10.1016/s2213-2600(22)00134-5","url":null,"abstract":"","PeriodicalId":326030,"journal":{"name":"The Lancet. Respiratory medicine","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123869451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1016/s2213-2600(22)00184-9
R. Houben, H. Esmail, F. Cobelens, C. M. Williams, A. Coussens
{"title":"Tuberculosis prevalence: beyond the tip of the iceberg.","authors":"R. Houben, H. Esmail, F. Cobelens, C. M. Williams, A. Coussens","doi":"10.1016/s2213-2600(22)00184-9","DOIUrl":"https://doi.org/10.1016/s2213-2600(22)00184-9","url":null,"abstract":"","PeriodicalId":326030,"journal":{"name":"The Lancet. Respiratory medicine","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115544365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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