Annals of Thoracic Medicine最新文献

This updated systematic review and meta-analysis pooled the results of previous clinical trials assessing the effects of pirfenidone and nintedanib on patients with pulmonary fibrosis. Scopus, the Cochrane Library, PubMed, and Web of Science were searched from the inception to April 12, 2025, to identify randomized controlled trials measuring the effect of pirfenidone and nintedanib on pulmonary fibrosis. Because of high methodological heterogeneity, we utilized a random-effects model (DerSimonian-Laird) to perform this meta-analysis. Finally, 18 articles with 20 randomized controlled trials were included in this meta-analysis. We found that compared to placebo, treatment with the two antifibrotic drugs increased forced vital capacity (FVC) predicted (weighted mean difference [WMD] 3.12%, 95% confidence interval [CI] [1.41, 4.82], I ² = 53.30%), FVC volume (WMD 87.44 ml, 95% CI [59.32, 115.57], I ² = 99.4%), and the distance walked in the 6-minute walk test (WMD 24.63 m, 95% CI [16.05, 33.22], I ² = 0.00%). However, compared to placebo, treatment with the two antifibrotic drugs did not significantly change the diffusing capacity of the lungs for carbon monoxide (WMD 1.38 ml/min/mmHg, 95% CI [-9.42, 12.18], I ² = 0.00%). Therapeutic benefits were observed for both pirfenidone and nintedanib and for both idiopathic pulmonary fibrosis (IPF) and non-IPF. Pirfenidone and nintedanib can improve lung function and functional capacity in patients with different types of pulmonary fibrosis.

Complicated hilar anatomy may be technically challenging for thoracic surgeons, especially during video-assisted thoracic surgery lobectomy. In such instances, to prevent hemorrhagic complications and conversion to open thoracotomy, several methods of proximal and distal vascular control have been proposed. Here, we present a technique of unnecessary occlusion of the main pulmonary artery and preserved pulmonary vein during a challenging thoracoscopic left lower lobectomy in patient with lung cancer and interlobar lymphadenopathy.

Objective: The objective of the study was to investigate the impact of CICARE communication nursing on the improvement of serum interleukin-10 (IL-10), interleukin-6 (IL-6), interleukin-4 (IL-4), and interleukin-2 (IL-2) and lung function in outpatients with acute bronchitis (AB).

Methods: One hundred and twenty suffers with AB who are treated in the outpatient department during Revised to 2021 to March 2023 are chosen and grouped according to the time of admission and different nursing practices. The control group consists of 60 patients from March 2021 to March 2022 who receive routine outpatient care; the experimental group consists of 60 patients from April 2022 to March 2023, and CICARE communication nursing is implemented additionally. Before and after intervention, the cognitive level of self-care knowledge, the level of peripheral blood inflammatory factors, and the improvement of lung function are compared.

Results: Before intervention, there were no remarkable differences in self-care knowledge cognition scores, peripheral blood inflammatory factors, and lung function levels between them (P > 0.05). After intervention, the cognitive scores of treatment coordination, medication method, daily attention, diet, and activity in experimental groups are superior to control group (P < 0.05). The levels of IL-10, IL-6, IL-4, and IL-2 in test groups are inferior to control group (P < 0.05). Forced vital capacity, forced expiratory volume in 1 s, maximum air volume, and peak flow rate in test groups are superior to control group (P < 0.05).

Conclusion: CICARE communication nursing can improve the cognition level of self-care knowledge of patients with AB, reduce the inflammatory response of the body, and promote the recovery of lung function.

Background: To evaluate the utility of thoracic ultrasound imaging (USI) in assessing the nature of pleural fluid (PF) using a scoring system.

Methods: The files of patients who underwent thoracic USI and thoracentesis due to PF accumulation were retrospectively examined. PF sonographic patterns and pleural thicknesses were retrieved from the USI records. Based on the Light's criteria, PFs were classified into transudative PF (TPF) and exudative PF (EPF). A scoring system was established based on the sonographic patterns and pleural thickness. Sonographic scores and other clinical, radiological, and demographic characteristics of the two groups were comparatively analyzed.

Results: Among the 64 cases analyzed, 32 (50%) were categorized as TPF. The average pleural thickness in the TPF group was 1.4 mm. The hypoechoic sonographic pattern rate in the TPF group (75%) was significantly different from that in the EPF group (p < 0.001). A hypoechoic sonographic pattern (p = 0.002) and pleural thickness >1.5 mm (p = 0.031) were independent predictors of EPF. The scoring system demonstrated a sensitivity of 84.38% and a specificity of 75.00% for predicting EPF when the sonographic score was ≥3.

Conclusion: Thoracic USI can serve as a noninvasive method to predict the nature of PFs by combining sonographic patterns and pleural thickness.

Background: This study aimed to estimate the prevalence and characteristics of rapid eye movement-related obstructive sleep apnea (REMrOSA) in the general Saudi Arabian population, contributing novel data to the field and providing insights into this specific OSA phenotype.

Methods: We analyzed data from a previously described Saudi population study targeting school employees aged 30-60 years. The study was conducted in two stages: an initial screening of 2682 participants using screening questionnaires and a confirmatory test of 346 participants using polysomnography (PSG). OSA was defined as an apnea-hypopnea index (AHI) ≥5. REMrOSA was identified on the basis of specific criteria, including a REM-AHI/non-REM (NREM)-AHI ratio ≥2, NREM-AHI <15, and REM duration ≥30 min. An extrapolation method was used to estimate the prevalence of REMrOSA in the general population.

Results: Among the 346 subjects who underwent PSG, 235 had OSA. Approximately one-third (30.64%) of these patients had REMrOSA, with a higher prevalence noted in females (38.03%) than in males (27.44%). The estimated prevalence of REMrOSA in the general Saudi population was 2.68%, with males (3.5%) being more affected than females (1.93%). Patients with REMrOSA presented lower AHI, Epworth Sleep Scale score, and arousal index than did those with non-REMrOSA (NREMrOSA). Logistic regression analysis indicated that patients with exclusive positional OSA (e-POSA) were 2.7 times more likely to have REMrOSA.

Conclusions: REMrOSA is a common condition among patients with OSA, with an estimated prevalence of 2.68% in the general Saudi population. Patients with REMrOSA tend to have milder disease, are less symptomatic, and are seen more in e-POSA.

Background: There are still disagreements about diagnostic criteria and treatment of progressive pulmonary fibrosis (PPF). Real-life data and survival analyses have a guiding role in clarifying this issue.

Methods: In this multicenter retrospective cohort study, real-life data of adult patients diagnosed with PPF and treated with antifibrotics for at least 6 months were examined.

Results: Of the 222 patients, 161 were treated with Nintedanib (N) and 61 with Pirfenidone (P). The most common PPF subtype was connective tissue disease-related interstitial lung disease (CTD-ILD) (53.2%). The progression rate was significantly higher in patients with usual interstitial pneumonia (UIP) (P = 0.003). A -3.1% (-49.2 ml) decrease was detected in forced vital capacity (FVC) in the 6^th month. The 6^th month and overall progression-free survival (PFS) rates were 83.3% and 51.8%. The 6^th month and overall clinical event-free survival (CEFS) rates were 89.6% and 53.6%. The survival rates for 6^th, 12^th, and entire follow-up periods were found to be 98.2%, 89.2%, and 77.5%. CT-ILD had the longest survival time (166.5 ± 9.2 months) and fibrotic hypersensitivity pneumonia had the shortest survival time (87.6 ± 9.2 months) (P = 0.011). N was advantageous in patients with UIP in terms of FVC loss and estimated survival. While PFS during the entire follow-up period was in favor of N, CEFS had no significant difference between drugs.

Conclusion: PPF subtypes have significant differences in terms of prognosis and survival. The effect of AF drugs on progression varies, especially among radiological patterns. An individualized approach is required in the diagnosis, follow-up, and treatment of patients with PPF.

Background: Chronic obstructive pulmonary disease (COPD) significantly contributes to global morbidity and mortality. Despite increasing COPD prevalence in Saudi Arabia, knowledge of and barriers to adherence to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines among respiratory therapists (RTs) remain limited. This study assessed RT awareness and barriers to adherence to the updated 2023 GOLD guidelines for COPD management in Saudi Arabia.

Methods: A modified cross-sectional online survey (snowball sampling) was distributed via social media from December 2023 to March 2024. The questionnaire covered eight domains: six assessing knowledge of COPD (overview, diagnosis, stable COPD therapy, pharmacological and nonpharmacological management of COPD and exacerbations, and COPD prevention and comorbidity), one on barriers to guideline adherence, and one on attitudes toward guidelines. A knowledge score (out of 39) was calculated. Descriptive statistics, tests for group differences, and regression analyses were conducted.

Results: Three hundred and twenty-six RTs (65.6% of males) participated. The average knowledge score was 18.9 ± 5.75 out of 39 (49.9% correct answers), indicating low COPD knowledge. Higher scores were associated with more COPD cases and bedside RT roles. While 53.1% of RTs expressed positive attitudes toward guideline utilization, only 16.9% of RTs reported recent use and 12.9% reported consistent use over the past 6 months. Key barriers included limited time for professional development (40.8%) and inadequate educational resources (37.7%).

Conclusion: This study reveals a knowledge gap and suboptimal COPD guidelines adherence among RTs in Saudi Arabia. Knowledge level correlated with COPD cases and RT role. Targeted interventions are needed to improve guideline adherence and COPD care.

Background: Ventilator-associated pneumonia (VAP) is a common complication in intensive care units (ICUs), particularly in patients undergoing prolonged mechanical ventilation. VAP rates vary significantly across regions, with the Middle East and North Africa (MENA) region experiencing relatively high incidences. This study systematically reviews and analyses the efficacy of various VAP prevention strategies in the adult population of the MENA region.

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Electronic databases (PubMed, Scopus, and CINAHL) were searched for studies from January 2004 to May 2024 that investigated VAP prevention strategies in adult ICU patients in the MENA region. Data extraction and quality assessment were performed by multiple independent reviewers. Meta-analysis was carried out using the DerSimonian and Laird random effect models.

Results: A total of 10 randomized clinical trials conducted in Iran and Tunisia were included. The studies evaluated various interventions, including respiratory care programs, oral care protocols, and tracheal suction techniques. Significant reductions in VAP incidence were observed with interventions such as aerosolized colistin and comprehensive oral care (e.g., clove mouthwash). However, certain interventions, such as ondansetron and N-acetylcysteine, did not yield significant benefits.

Conclusion: This meta-analysis highlights effective VAP prevention strategies in the MENA region, with notable improvements in patient outcomes. These findings can potentially help in developing policies and guidelines to enhance VAP prevention efforts across ICUs in the region. Further research is essential to address existing gaps and refine prevention strategies.