Expert review of respiratory medicine最新文献

Introduction: Respiratory viral pneumonias are a leading cause of severe respiratory failure and intensive care unit (ICU) admission worldwide. Although viral infection itself drives significant morbidity and mortality, secondary bacterial and fungal superinfections represent a critical 'double threat' in critically ill adults, exacerbating lung injury, prolonging organ dysfunction, and complicating antimicrobial management. Experience from the Influenza A (H1N1) pdm09 and SARS-CoV-2 pandemics highlights a persistent mismatch between low documented bacterial co-infection rates and widespread empiric antibiotic exposure, underscoring diagnostic uncertainty and antimicrobial stewardship challenges in the ICU.

Areas covered: This review examines the epidemiology, immunopathogenesis, and diagnostic approaches to bacterial and fungal superinfection in adult ICU patients with severe viral pneumonia. Evidence is synthesized from large ICU cohorts, pandemic data, and established consensus definitions for influenza- and COVID-19-associated pulmonary aspergillosis (IAPA, CAPA). The review discusses advances in molecular diagnostics, lower respiratory tract sampling, bronchoalveolar lavage - based mycology, and biomarker-guided strategies, with a focused literature search of ICU-specific studies.

Expert opinion: Bacterial and fungal superinfections, while infrequent, carry substantial clinical impact in severe viral pneumonia. A multimodal, ICU-adapted diagnostic strategy integrating pathogen detection with host-response assessment is essential to support timely therapy, enable antimicrobial de-escalation, and align superinfection management with stewardship principles.

Introduction: Central sleep apnea (CSA) affects up to one-third of patients with heart failure (HF) and is linked to sympathetic activation, arrhythmias, impaired quality of life, and worse prognosis. Understanding epidemiology, mechanisms, and evolving therapies is essential as management recommendations are rapidly changing.

Areas covered: This review synthesizes data retrieved from a PubMed database search on CSA prevalence across HF phenotypes, delineates pathophysiology, and appraises therapies. We performed a structured search for randomized trials, large observational studies, meta-analyses, and recent guidance, with focused appraisal of the latest statements from the American Academy of Sleep Medicine (AASM) and the European Respiratory Society (ERS).

Expert opinion: The field is shifting from one size fits all apnea-hyponea index (AHI) suppression to phenotype-guided care, prioritizing patient centered and cardiac outcomes. Integrating endotyping, remote monitoring, and HF co-management is key. Major gaps include optimal patient selection, long-term cardiovascular endpoints, and harmonization of guideline recommendations. If optimization of HF therapy and a continuous positive airway pressure (CPAP) trial fail to improve symptoms, adaptive servoventilation (ASV) becomes the preferred therapeutical option.

Introduction: PubMed was used for a literature search (1990-2025) on the minimally invasive surgical approaches for pneumothorax, which have evolved markedly, with video-assisted thoracic surgery (VATS) emerging as a preferred procedure. Systematic reviews of randomized control trials indicate that VATS is less invasive than traditional thoracotomy. Furthermore, uniportal VATS provides less postoperative pain and better cosmetic outcomes than thoracotomy. Currently, uniportal VATS seems preferred as the minimally invasive surgical approach for pneumothorax. New devices such as small-diameter thoracoscopes and forceps, which are used in uniportal subxiphoid VATS and uniportal subcostal robot-assisted thoracic surgery, may contribute to reducing the postoperative incidence of intercostal neuralgia and enhancing satisfaction with the cosmetic results.

Areas covered: The ideal surgical approaches for pneumothorax, referencing guidelines, and studies from various countries.

Expert opinion: This review explores various aspects of minimally invasive surgical approaches for pneumothorax. Uniportal VATS for pneumothorax via the intercostal approach is commonly performed worldwide and ensures high surgical quality. This review discusses what should be performed within the thoracic cavity to reduce the postoperative recurrence rate of pneumothorax, problems associated with thoracic adhesions that may be disadvantageous for pneumothorax patients in the future, and the latest surgical approaches that may become mainstream.

Introduction: The fibrotic interstitial lung diseases (f-ILD) are often progressive and debilitating lung diseases with significant symptom burden and impaired quality of life. Pulmonary rehabilitation (PR) has demonstrated improvements in dyspnea, physical function, and respiratory-related quality of life (RR-QoL) in patients with -f-ILD but had limited uptake and completion in real-world settings.

Areas covered: A literature review was completed on the impact and limitations of traditional PR in f-ILD, with additional perspective on the use of home-based approaches and implementation of health coaching. Barriers to traditional center-based PR programs include patient and systems-based factors such as unawareness of benefit, emotional or psychological distress, and limited access. Home-based PR may address these limitations by removing travel barriers, increasing access with remote supervision and monitoring, and promoting social support by connecting care with familiar settings. Studies involving home-based PR in ILD have shown promise with improving functional and quality of life outcomes and high compliance rates. Health coaching is a collaborative paradigm for fostering behavior change and has demonstrated positive impact in the management of chronic diseases.

Expert opinion: A combination of health coaching with home-based PR may address ongoing challenges of PR uptake and compliance as well as expand PR as a holistic and comprehensive intervention.

Introduction: Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition characterized by chronic respiratory symptoms causing persistent, often progressive airflow obstruction. Strength training is a therapeutic option to prevent and/or reverse muscle dysfunction in COPD patients. Objective: to analyze the literature on the effects of strength training in COPD patients.

Methods: A systematic review from the last ten years was conducted in August 2024 across PubMed, Scopus, WOS, Medline and CINAHL databases. The search included studies examining resistance training for upper and lower limbs. Methodological quality was analyzed using the PEDro scale and the RoB2 was used for risk of bias.

Results: Six randomized controlled trials were eligible for inclusion, obtaining an excellent or good methodological quality. Most repeated variables were exercise capacity, quality of life and muscle strength, finding statistically significant positive results in all of them.

Conclusions: Strength training appears to be safe and effective for COPD treatment, with improvements in exercise capacity, activities of daily living, muscle strength, lung function, quality of life and inflammatory levels. However, scientific evidence on this topic is scarce, and future high-quality, long-term studies are necessary to establish standardized protocols and assess the sustained benefits of strength training in COPD patients.Protocol registration: Identifier is CRD42024572717.

Introduction: Airway management is one of the most important interventions performed by paramedics in the prehospital setting. While the standard of care for over 40 years, multiple studies highlight pitfalls associated with prehospital airway management in adults. Considerably less research describes prehospital airway management in children.

Areas covered: We searched PubMed for articles from 2000 to present using the keywords 'children,' 'airway management,' 'intubation intratracheal,' 'Emergency Medical Services,' and 'paramedic.' Studies highlight the pitfalls of adult prehospital endotracheal intubation such as tube misplacement and dislodgement, multiple and failed insertion attempts, interruptions in chest compressions, and inadvertent hyperventilation. Multicenter clinical trials including the PART and Airways-2 trials support the use of newer supraglottic airways as potential alternatives to intubation in adults. Only limited data describe prehospital airway management in children, including only one clinical trial performed 25 years ago.

Expert opinion: New studies are needed to guide paramedic pediatric airway management practices. The Pediatric Prehospital Airway Resuscitation Trial (Pedi-PART) is an ongoing multicenter clinical trial that will provide critical new knowledge to guide prehospital pediatric airway management practices.

Background: Pleuroparenchymal fibroelastosis (PPFE) is an upper lobe - predominant interstitial pneumonia pattern that can be idiopathic or secondary and has unclear clinical characteristics, disease course, and prognostic factors. This study analyzed PPFE patient characteristics, identified mortality predictors, and compared disease progression between idiopathic and secondary PPFE.

Research design and methods: We retrospectively identified patients with PPFE and analyzed demographic, clinical, radiologic, and pathologic data. Linear regression mixed models were used to assess predictors of mortality and lung function decline.

Results: Among 81 patients identified, 73% were women, median age was 69.4 years, and 75% were nonsmokers. Idiopathic PPFE comprised 46% of cases; secondary PPFE was most commonly familial (40%) or autoimmune related (33%). Over a median follow-up of 777 days, 38% died; the 5-year survival rate was 53%. Mortality risk did not differ between idiopathic and secondary PPFE. Lower body mass index, lower forced vital capacity (FVC) at diagnosis, and smoking history predicted mortality. The decline in FVC was slower in idiopathic PPFE than secondary PPFE.

Conclusions: Idiopathic and secondary PPFE differ in FVC decline but not in mortality risk. Familial and autoimmune conditions are the most common secondary causes.

Introduction: Artificial intelligence (AI) has shown promise in enhancing the detection and stratification of obstructive sleep apnea (OSA) using clinical and demographic data. This systematic review assessed the effectiveness of AI models, methodological quality, and future research needs.

Methods: Following PRISMA guidelines, a systematic search of PubMed (2014-2024) identified studies applying AI to detect or stratify OSA using clinical/demographic data, validated against polysomnography or cardiorespiratory polygraphy, and reporting performance metrics such as the area under the curve (AUC). Studies primarily based on wearable devices were excluded. Methodological quality and risk of bias were evaluated using the PROBAST tool.

Results: Of 447 records, 26 met inclusion criteria. Common algorithms included decision trees, support vector machines, and neural networks, frequently using variables such as age, BMI, neck circumference, and comorbidities. AUC values ranged from 0.62 to 0.93, with most exceeding 0.80. Research output increased substantially between 2021 and 2024. Methodological heterogeneity and limited external validation hindered comparability. Exclusion of incomplete cases was a recurrent issue.

Conclusions: AI models show potential for improving OSA detection, but methodological limitations restrict generalizability. Future studies should prioritize external validation, diverse populations, and adherence to standardized reporting frameworks to enable clinical translation.

Protocol registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251025868 identifier is CRD420251025868.