Respiration最新文献

{"title":"National Registry for Home Mechanical Ventilation in Children from Turkey.","authors":"Neval Metin Çakar, Merve Selçuk Balcı, Azer Kılıç Başkan, Hüseyin Arslan, Füsun Ünal, Yeliz Koç, Gözde Cavıldak Karaaslan, Sümeyye Sinan, Fatih Ercan, Gökçen Ünal, Hanife Tuğçe Çağlar, Zeynep Efşan Başer, Harun Mamaç, Sinem Can Oksay, Zeynep Reyhan Onay, Raziye Atan, Birce Sunman, Havva İpek Demir, Ece Halis, Bahar Girgin Dindar, Secahattin Bayav, Suat Savaş, Merve Korkmaz, Ebru Köstereli, Selçuk Uzuner, Hakan Yazan, Ali Özdemir, Abdurrahman E Başaran, Gökçen Kartal Ozturk, Ali Ersoy, Beste Özsezen, Ayşen Başaran, Özlem Keskin, Tuğba Ramaslı Gürsoy, Mina Hızal, Gizem Özcan, Pinar Ergenekon, Ayşe A Kılınc Sakallı, Fazilet Karakoc, Bülent Karadağ, Haluk Çokuğraş, Sevgi Pekcan, Tuğba Şişmanlar Eyüboğlu, Ayse Tana Aslan, Saniye Girit, Figen Gülen, Nazan Çobanoğlu, Velat Şen, Yakup Canıtez, Zeynep Seda Uyan, Erkan Çakır, Pınar Ay, Nilay Baş İkizoğlu, Melih Hangül, Güzin Cinel, Nagehan Emiralioğlu, Ela Erdem Eralp, Sedat Öktem, Yasemin Gökdemir","doi":"10.1159/000543343","DOIUrl":"10.1159/000543343","url":null,"abstract":"<p><strong>Background: </strong>Advances in neonatal and pediatric intensive care have improved patient survival rates, emphasizing the need for respiratory support in cases of chronic respiratory failure, resulting in the establishment of the Turkish National Pediatric Patients Receiving Home Mechanical Ventilation (HMV) Support Registration System in 2023. This study aims to present the initial findings of the registry.</p><p><strong>Methods: </strong>In this cross-sectional study, epidemiological and demographic data were obtained from the registry and compared between invasive ventilation (IV) and non-IV (NIV) groups.</p><p><strong>Results: </strong>The study included 952 patients registered from 23 centers with a median (interquartile range) age of 6.0 (3.0-12.0) years. IV support was observed in 51.1% of patients (n = 486). There was no difference in sex between IV and NIV groups, but a significant difference in age, nutrition, mobility status, and education were observed between the subgroups. The largest patient group had neuromuscular disease, with spinal muscular atrophy being the most common primary diagnosis (15.7%). Most of the caregivers (78.7% in the NIV group and 93.8% in the IV group) received formal training before the initiation of HMV.</p><p><strong>Conclusion: </strong>Turkey's first registry for pediatric HMV patients is introduced. This system helps understand and solve mobility and education issues for these patients in our country. Collaboration with relevant ministries is crucial. In addition, although most of the caregivers have received training before discharge, efforts are still needed to ensure that this rate is 100%. The long-term results will be presented in the future.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Spray Cryotherapy on Airway Secretions in Canine Models of Chronic Bronchitis and Mechanism Insights.","authors":"Bingbing Wang, Hongxia Duan, Xuan Li, Xuan Long, Shuanshuan Xie, Changhui Wang","doi":"10.1159/000543388","DOIUrl":"10.1159/000543388","url":null,"abstract":"<p><strong>Introduction: </strong>Bronchoscopic spray cryotherapy (SCT) is a novel treatment showing promise for chronic bronchitis (CB), characterized by excessive mucus secretion and productive cough. A large animal model for preclinical research of SCT is lacking, and its treatment's efficacy and mechanisms for CB are not well understood.</p><p><strong>Methods: </strong>Eight Labradors were exposed to 200 ppm SO2 for 6 months to develop a CB model. Evaluations included pulmonary resistance, bronchoalveolar lavage fluid (BALF), CT images, and pathology. After model validation, 6 dogs received SCT and were observed for short-term (7 days) and long-term (30 days) outcomes. Metrics included pulmonary resistance, bronchoscopy findings, and BALF analysis for inflammatory factors, acetylcholine, and mucins. Bronchial tissue was assessed via HE staining, electron microscopy, and IHC staining. BEAS-2B cells were used to study MUC5AC expression in response to LPS and acetylcholine.</p><p><strong>Results: </strong>SO2 exposure led to persistent cough, increased pulmonary resistance, goblet cell hyperplasia, and inflammation. Mucin, MUC5AC, and MUC5B levels in BALF increased over time, which validated the CB model. SCT treatment reduced mucus and pulmonary resistance, improved bronchial structure, and decreased goblet cells. SCT significantly reduced BALF mucin, MUC5AC, MUC5B, acetylcholine, IL-6, INF-γ, TNF-α, and IL-10, and bronchial MUC5AC and CHRM3. In the LPS treatment BEAS-2B cells, MUC5AC expression increased when acetylcholine pretreatment concentration increased.</p><p><strong>Conclusion: </strong>The SO2 inhalation protocol effectively establishes a CB model in dogs. SCT effectively treats CB by reducing mucin levels and may lower MUC5AC expression by decreasing acetylcholine and CHRM3.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-14"},"PeriodicalIF":3.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142984389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association between Aminoglycoside Exposure and Ototoxicity in Children with Cystic Fibrosis.","authors":"Cansu Yilmaz Yegit, Pinar Ergenekon, Mürüvvet Yanaz, Nezafet Ozturk Akar, Fatma Toktas Yavuz, Hale Molla Kafi, Abdülhamit Çollak, Nilüfer Bal, Özge Gedik Toker, Özge Meral, Ahmet Ataş, Halide Çetin Kara, Yetkin Ayhan, Aynur Guliyeva, Mine Yuksel Kalyoncu, Merve Selçuk Balcı, Şeyda Karabulut, Gamze Taştan, Burcu Uzunoglu, Nesibe Karasu, Yesim Oruc, Melda Acar, Ali Cemal Yumuşakhuylu, Remzi Dogan, Emine Deniz Gozen Tan, Pinar Ata, Ayşe Ayzıt Kılınç Sakallı, Saniye Girit, Erkan Cakir, Yasemin Gokdemir, Ela Erdem Eralp, Ayca Ciprut, Fazilet Karakoc, Bulent Karadag","doi":"10.1159/000541447","DOIUrl":"10.1159/000541447","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Materials/methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"48-57"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balloon Pulmonary Angioplasty for Chronic Thromboembolic Pulmonary Disease: Success Rate and Complications among Different Patient Populations.","authors":"Zhihui Fu, Wanmu Xie, Qian Gao, Shuai Zhang, Zhu Zhang, Yunxia Zhang, Dingyi Wang, Ting Yao, Jinzhi Wang, Xincheng Li, Lu Sun, Qiang Huang, Peiran Yang, Zhenguo Zhai","doi":"10.1159/000540779","DOIUrl":"10.1159/000540779","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"110-123"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141976504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cone Beam Computed Tomography-Guided Navigation Bronchoscopy with Augmented Fluoroscopy for the Diagnosis of Peripheral Pulmonary Nodules: A Step-by-Step Guide.","authors":"Ferhat Beyaz, Roel L J Verhoeven, Nico Hoogerwerf, Jo M J Mourisse, Erik H F M van der Heijden","doi":"10.1159/000541691","DOIUrl":"10.1159/000541691","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Conclusion: </strong>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.</p><p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"216-228"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11887993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A High-Intensity versus Moderate-Intensity Exercise Training Programme in Alpha-1 Antitrypsin Deficiency-Related COPD (IMAC): A Randomized, Controlled Trial.","authors":"Inga Jarosch, Tessa Schneeberger, Rainer Gloeckl, Daniela Kroll, Clancy Dennis, Wolfgang Hitzl, Klaus Kenn, Andreas Rembert Koczulla","doi":"10.1159/000541448","DOIUrl":"10.1159/000541448","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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]).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"200-205"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Efficacy and Safety of Different Types of One-Way Valves in Endoscopic Lung Volume Reduction in Patients with Severe Lung Emphysema.","authors":"Thomas Sgarbossa, Philipp Borchers, Jacopo Saccomanno, Katharina Ahrens, Hannah Friederike Wüstefeld, Eva Pappe, Uta Wuelfing, Ulrich Klein, Martin Witzenrath, Franz Stanzel, Christian Grah, Ralf-Harto Hübner","doi":"10.1159/000542806","DOIUrl":"10.1159/000542806","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"281-289"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11975321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surviving Critical Care: A Follow-Up Study Assessing Pulmonary Function, Cardiopulmonary Exercise Testing, and Quality of Life in COVID-19-Affected Patients.","authors":"Luisa Engel, Stephan Strassmann, Michaela Merten, Simone Schaefer, Johanna Färber, Wolfram Windisch, Christian Karagiannidis","doi":"10.1159/000540598","DOIUrl":"10.1159/000540598","url":null,"abstract":"<p><strong>Introduction: </strong>Survivors of severe COVID-19 face complex challenges and a high degree of pulmonary sequelae. Therefore, we aim to describe their ongoing health burden.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"15-25"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung Tensioning Device Coil Treatment in Patients with Severe Emphysema: A Prospective Safety and Feasibility Trial (EFFORT).","authors":"Sharyn A Roodenburg, Karin Klooster, Jorine E Hartman, Konstantina Kontogianni, Judith M Brock, A Susanne Dittrich, Marlies van Dijk, T David Koster, Felix J F Herth, Dirk-Jan Slebos","doi":"10.1159/000541366","DOIUrl":"10.1159/000541366","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"58-68"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multidimensional Approach to the Management of Patients in Prolonged Weaning from Mechanical Ventilation: The Concept of Treatable Traits - A Narrative Review.","authors":"Franziska C Trudzinski, Benjamin Neetz, Jana C Dahlhoff, Finn Moritz Wilkens, Stephan Katzenschlager, Sebastian Fähndrich, Axel Kempa, Claus Neurohr, Armin Schneider, Biljana Joves, Urte Sommerwerck, Ralf Eberhardt, Florian Bornitz, Felix J F Herth, Julia D Michels-Zetsche","doi":"10.1159/000541965","DOIUrl":"10.1159/000541965","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Summary: </strong>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.</p><p><strong>Key message: </strong>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.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"240-254"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}