Respiration最新文献

{"title":"Contemporary Sedation Strategies for Mechanical Ventilation: Balancing Patient Outcomes, Delirium Prevention, and Early Recovery.","authors":"Luigi La Via, Giuseppe Cuttone, Giovanni Misseri, Tarek Senussi Testa, Daniele Salvatore Paternò, Federico Pappalardo, Nicolò Patroniti","doi":"10.1159/000550984","DOIUrl":"https://doi.org/10.1159/000550984","url":null,"abstract":"<p><strong>Background: </strong>The traditional deep sedation approach has been linked to prolonged ventilation, increased delirium incidence, and long-term cognitive impairment. Modern evidence now supports lighter sedation protocols with daily interruptions and spontaneous breathing trials.</p><p><strong>Summary: </strong>The authors explore the pathophysiology of sedation-related complications including delirium, ventilator-induced diaphragmatic dysfunction, and ICU-acquired weakness. They analyze clinical assessment tools ranging from validated scales to emerging objective monitoring technologies (processed electroencephalography, automated pupillometry). The pharmacological discussion contrasts traditional benzodiazepines with newer alternatives (propofol, dexmedetomidine, remifentanil) that show improved outcomes regarding delirium, ventilation duration, and cognitive function. Critical examination of sedation-ventilator mode interactions and comparison of analgosedation versus traditional sedation-first paradigms addresses unresolved clinical questions in integrating these therapeutic domains. Structured approaches including goal-oriented protocols and the ABCDEF bundle are presented as implementation frameworks. The review highlights non-pharmacologic interventions as essential complements to drug therapy: sleep promotion, early mobilization, family engagement, and environmental modifications. Special consideration is given to unique populations requiring tailored approaches, including geriatric, neurologic, cardiac, and COVID-19 patients.</p><p><strong>Key messages: </strong>The authors conclude by addressing future directions in sedation practice, emphasizing cost-effectiveness analysis, quality improvement initiatives, and research priorities that will guide the next phase of sedation management in mechanical ventilation.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-15"},"PeriodicalIF":2.6,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797540","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":"Identification of Clinical Phenotypes in Young Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Multicenter Cohort Study.","authors":"Jiaqi Pu, Hailong Wei, Huiqing Ge, Huiguo Liu, Jianchu Zhang, Xianhua Li, Pinhua Pan, XiuFang Xie, Mengqiu Yi, Lina Cheng, Hui Zhou, Jiarui Zhang, Lige Peng, Jiaxin Zeng, Xueqing Chen, Haixia Zhou, Qun Yi","doi":"10.1159/res/aepag003","DOIUrl":"10.1159/res/aepag003","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the rising recognition of chronic obstructive pulmonary disease (COPD) in younger adults (20-50 years), the clinical heterogeneity of this population during acute exacerbations (AECOPD) remains undefined, obscuring precision risk stratification and personalized management.</p><p><strong>Methods: </strong>This study analyzed data from a nationwide, multicenter, prospective cohort across 10 tertiary hospitals in China (September 2017-July 2021). From 13,993 eligible patients, we identified 334 young AECOPD cases. Unsupervised K-means clustering was applied using nine biomarkers of inflammation, hematologic function, and structural lung damage. To contextualize its clinical relevance, the disease severity of the identified high-risk phenotype was benchmarked against the elderly AECOPD cohort (n = 13,659).</p><p><strong>Results: </strong>Cluster analysis identified two distinct phenotypes. The \"Systemic Inflammatory Phenotype\" (n = 179) was characterized by a pervasive inflammatory state (elevated C-reactive protein, neutrophils, white blood cell, procalcitonin, and fibrinogen) and significantly worse lung function. In contrast, the \"Eosinophilic Phenotype\" (n = 155) exhibited an eosinophil-predominant profile. Critically, the systemic inflammatory phenotype experienced a more severe hospital course, with significantly higher rates of invasive mechanical ventilation (3.9% vs. 0.0%, p = 0.017), noninvasive ventilation (23.5% vs. 10.3%, p = 0.003), and ICU admission (6.7% vs. 1.3%, p = 0.026). Notably, the overall disease severity of this high-risk phenotype was comparable to the elderly AECOPD cohort.</p><p><strong>Conclusion: </strong>We identified a high-risk systemic inflammatory phenotype among young AECOPD inpatients, demonstrating clinical acuity on par with elderly patients. These findings challenge the conventional age-centric risk paradigm and advocate for a shift toward phenotype-driven assessment to enable early identification and targeted management of young AECOPD patients at the greatest risk.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148797595","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":"Embracing Artificial Intelligence while Preserving Clinical Expertise: Raising Awareness of Artificial Intelligence-Induced Procedural Deskilling in Interventional Pulmonology.","authors":"Guido Marchi","doi":"10.1159/000553191","DOIUrl":"https://doi.org/10.1159/000553191","url":null,"abstract":"","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-3"},"PeriodicalIF":2.6,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702048","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":"Challenges and Barriers in Pediatric to Adult Transition in Chronic Pulmonary Diseases in Italy: A Nationwide Survey.","authors":"Martina Mazzoni, Martina Bove, Josè Alberto D'Anna, Alessandro Onofri, Maria Giovanna Paglietti, Cinzia Mautone, Laura Tenero, Valentina Tranchino, Cristiana Indolfi, Rachele Antignani, Pierluigi Vuilleumier, Annalisa Allegorico","doi":"10.1159/000551063","DOIUrl":"10.1159/000551063","url":null,"abstract":"<p><strong>Introduction: </strong>Advances in medical research, early diagnosis, and therapeutic strategies have significantly improved survival among children with chronic pulmonary diseases (CPDs), leading to a growing population of adolescents and young adults transitioning to adult care. Despite this demographic shift, healthcare systems, including Italy's, remain inadequately equipped to manage the evolving needs of these patients. This study aims to identify key barriers and unmet needs within the Italian healthcare system regarding the transition from pediatric to adult care for individuals with CPDs.</p><p><strong>Methods: </strong>A nationwide survey was conducted among members of IPRS (Italian Pediatric Respiratory Society) through a questionnaire consisting of 13 questions. The survey was sent between June and August 2023, with responses collected until July 2024.</p><p><strong>Results: </strong>A total of fifty-one responses were collected from pulmonologists, hospital-based pediatricians, primary care pediatricians, and adult pulmonologists from 14 Italian regions. Of these, 64.7% reported the absence of a structured transition program within their institutions. Where programs existed, they primarily targeted severe asthma (60.6%) and PCD or non-CF bronchiectasis (24.2%). Only 15.7% of respondents consistently addressed transition with patients and families, and 13.8% of centers had dedicated transition clinics. Proposed improvements included the establishment of specialized clinics (76.5%) and targeted professional training (72.5%).</p><p><strong>Conclusions: </strong>The transition of CPDs patients in Italy is currently fragmented and underdeveloped. Standardized protocols, dedicated transition services, interdisciplinary collaboration, continuous education, and involvement of patient associations are essential to ensure continuity of care and optimize long-term health outcomes.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-9"},"PeriodicalIF":2.6,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13641742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670529","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":"Pulmonary Hypertension in Patients with Moderate to Severe Hypersensitivity Pneumonitis.","authors":"Tjasa Kamenski-Rathmanner, Adrienn Tornyos, Luka Brcic, Emina Talakic, Helmut Prosch, Izidor Kern, Holger Flick, Grazyna Kwapiszewska, Alberto Benazzo, Horst Olschewski, Nikolaus Kneidinger, Philipp Douschan, Vasile Foris, Teresa John, Martin Trinker, Katarina Zeder, Gabor Kovacs","doi":"10.1159/000553575","DOIUrl":"10.1159/000553575","url":null,"abstract":"<p><strong>Introduction: </strong>Hypersensitivity pneumonitis (HP) is characterized by a complex immunological reaction of the lung that may lead to chronic interstitial lung disease (ILD). Pulmonary hypertension (PH) may aggravate the clinical picture. We aimed to assess the prevalence of PH in 2 independent cohorts including patients with moderate and severe HP.</p><p><strong>Methods: </strong>We retrospectively analyzed the data of HP patients with severe ILD undergoing lung transplantation (cohort-1) and invited HP patients with mild disease participating at pulmonary rehabilitation for a prospective screening for PH (cohort-2). The presence of PH was assessed by both echocardiography and right heart catheterization (RHC).</p><p><strong>Results: </strong>In cohort-1 (n = 55, median age 57 [95% CI 52-60] years, 59% male, forced vital capacity [FVC] 37 [35-45] %predicted), echocardiographic systolic pulmonary arterial pressure (sPAP) was available in 31 patients and showed elevated values (53 [45-63] mm Hg). Sixteen patients had a high probability of PH (sPAP >50 mm Hg). RHC was performed based on clinical suspicion of PH or as part of the clinical assessment for transplantation in 21 patients, revealing a mean pulmonary arterial pressure (mPAP) of 28 (24-33) mm Hg and a pulmonary vascular resistance (PVR) of 2.8 (2.2-3.4) Wood units in this group; PH was confirmed in 15 patients (71% of those undergoing RHC, 27% of the total cohort). In cohort-2 (n = 96, median age 62 [60-65] years, 66% male, FVC 98 [95-104] % predicted), echocardiographic screening was available in 88 patients and showed upper-normal sPAP values (29 [28-31] mm Hg). One (1%) patient had a high probability of PH. Following noninvasive clinical assessment, RHC was performed in 13 patients with suspected PH. Hemodynamic measurements showed an mPAP of 19 (16-21) mm Hg and a PVR of 1.9 (1.7-2.8) Wood units in this group, and PH was confirmed in 5 patients (38% of those undergoing RHC, 5% of the total cohort). All 5 patients had a plausible alternative explanation for their PH.</p><p><strong>Conclusion: </strong>PH is a frequent complication in patients with HP and severe ILD. In HP patients with mild disease, PH is uncommon and alternative causes should be considered.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-9"},"PeriodicalIF":2.6,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621277","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":"Artificial Intelligence in Interventional Pulmonology.","authors":"Zhen-Ding You, Wei He, Jing Liu, Jiaxin Tang, Hongjia Li, Zhaohui Li, Yanfei Bai, Shiyue Li, Changhao Zhong","doi":"10.1159/000551437","DOIUrl":"https://doi.org/10.1159/000551437","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) has revolutionized interventional pulmonology (IP) by enhancing diagnostic accuracy, procedural efficiency, and training standardization. This review synthesizes current advancements and applications of AI across four key domains: education, imaging, navigation, and robotic bronchoscopy systems (RBS).</p><p><strong>Summary: </strong>In education, AI-powered convolutional neural networks (CNNs) improve airway structure recognition with an accuracy of 94.7%, thereby reducing learning curves and minimizing diagnostic errors. For imaging, deep learning models achieve lesion identification accuracy comparable to that of senior physicians (area under the curve: 0.940-0.981), enabling real-time intra-procedural guidance. Navigation technologies, such as virtual bronchoscopic navigation (VBN) and electromagnetic navigation bronchoscopy (ENB), enhance accessibility to peripheral lesions, achieving diagnostic yields of 77.9%-94.4% with excellent safety. RBS integrate AI-driven navigation and real-time imaging, achieving biopsy success rates up to 98.8% and diagnostic yield over 90%, while minimizing pneumothorax risks. Despite these advancements, challenges remain in algorithm validation, data privacy, and ethical considerations. AI demonstrates transformative potential in standardizing bronchoscopy practices, expanding access to underserved regions, and advancing personalized treatments.</p><p><strong>Key message: </strong>AI significantly enhances the diagnostic accuracy and procedural safety of IP across education, imaging, navigation, and robotic systems; despite ongoing challenges in algorithm validation, AI is propelling the field toward standardized practices and personalized medicine.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-12"},"PeriodicalIF":2.6,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621287","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":"Predictor of Mortality in Obstructive Sleep Apnea: Results of Explainable Deep Learning-Based Survival Analysis from a 15-Year Follow-Up.","authors":"Gaetano Pagano, Giorgio Castellana, Giovanni D Apos Addio, Lucia Palazzo, Maria Aliani, Patrizia Guido, Francesco Berloco, Pietro Maria Marvulli, Vladimiro Suglia, Simona Colucci, Donato Lacedonia, Vitoantonio Bevilacqua, Mauro Carone","doi":"10.1159/000552344","DOIUrl":"10.1159/000552344","url":null,"abstract":"<p><strong>Introduction: </strong>Obstructive sleep apnea (OSA) is a respiratory disorder with comorbidities of several nature, from cardiovascular to renal ones. OSA is typically treated through continuous positive airway pressure (CPAP), but more investigations are needed to confirm its benefits.</p><p><strong>Methods: </strong>In this work, survival analysis has been exploited and enhanced with eXplainable Artifical Intelligence (XAI) to investigate the impact of comorbidities and compare the model reliability. The dataset encompasses both clinical and polysomnography-based data for a total of 45 different features.</p><p><strong>Results: </strong>A total of 1,394 OSA patients followed for 15 years were enrolled. All the selected features have been studied by means of DL-models and time-dependent XAI techniques. The variables impacting on mortality are reported below in descending order with respect their importance: (1) age, years of CPAP, renal dysfunction, COPD, body mass index categories, sex, and anemia for the CoxTime; (2) age, apnea hypopnea index, renal dysfunction, SaO₂ min, years of CPAP, COPD, and anemia for the LogHazard.</p><p><strong>Conclusion: </strong>Advancing age, severity of OSA, comorbidity, including chronic kidney disease, COPD, and anemia, are crucial contributors to increased mortality.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-10"},"PeriodicalIF":2.6,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579878","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":"Clinical Impact of Bacterial Colonization of the Airways during a Stent Trial in Patients with Excessive Central Airway Collapse.","authors":"Marta Diez-Ferrer, Hamad Nasim, Diana Espinoza, Mihir Parikh, Jason Beattie, Kai E Swenson, Jennifer L Wilson, Sidhu Gangadharan, Adnan Majid","doi":"10.1159/000552780","DOIUrl":"10.1159/000552780","url":null,"abstract":"<p><strong>Introduction: </strong>Short-term airway stenting is performed in patients with severe excessive central airway collapse to assess whether airway stabilization leads to symptomatic improvement, thereby supporting surgical management. Interpretation of stent trials, however, may be confounded by complications such as bacterial colonization and granulation tissue formation.</p><p><strong>Methods: </strong>This is a retrospective review of patients who underwent airway stenting at our institution between 2016 and 2022. We assessed the incidence of airway bacterial colonization, defined as conversion from a negative pre-stent to a positive post-stent bronchial wash (BW) culture, and the development of granulation tissue 7-14 days after stent placement, as well as their correlation with clinical outcomes.</p><p><strong>Results: </strong>Pre- and post-stent bronchial washings were available from 101 stent trials. Airway bacterial colonization was observed in 40% of cases, with S. aureus accounting for 79%. Granulation tissue developed in 63% of cases, and it was significantly more frequent in silicone stents compared to uncovered self-expanding metallic airway stents (odds ratio [OR] = 16; 95% CI: 1.6-166.7, p = 0.02). It was also more frequent in patients with positive post-stent BW (adjusted OR = 2.6; 95% CI: 0.9-6.6, p = 0.05) and in cases of early colonization (adjusted OR = 2.98; 95% CI: 0.9-9.5, p = 0.065). Although colonization and granulation tissue occurred more frequently in patients with no clinical improvement, neither was independently associated with increased odds of a negative stent trial.</p><p><strong>Conclusion: </strong>Bacterial colonization, particularly with S. aureus, occurs early after stent deployment and is associated with granulation tissue formation. However, these complications did not significantly affect clinical stent trial outcomes.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-10"},"PeriodicalIF":2.6,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148472392","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":"Sex Differences in Long-Term Survival of Chronic Obstructive Pulmonary Disease Patients following Initiation of Home Noninvasive Ventilation after Acute Hospitalization due to Respiratory Failure.","authors":"Oleh Myronenko, Vasile Foris, Wilfried Fritz, Gabor Kovacs, Daniela Kleinschek, Andrea Olschewski, Horst Olschewski","doi":"10.1159/000553559","DOIUrl":"10.1159/000553559","url":null,"abstract":"<p><strong>Introduction: </strong>Home noninvasive ventilation (HNIV) is an established therapy for chronic obstructive pulmonary disease (COPD) with chronic respiratory failure. However, outcomes following HNIV initiation after discharge from the hospital after acute COPD exacerbation remain poorly investigated, in particular sex-related factors.</p><p><strong>Methods: </strong>We conducted a single-center, retrospective cohort study on COPD patients admitted to our respiratory care unit (RCU) for acute exacerbation with respiratory failure who were discharged home with newly established HNIV between 2013 and 2019. The primary endpoint was all-cause mortality after discharge from RCU. Sex-stratified survival analysis was performed using Kaplan-Meier curves, Cox proportional hazards models, and interaction models incorporating sex and clinical covariates, including lung function test and blood gases assessed at discharge.</p><p><strong>Results: </strong>A total of 84 patients fulfilled all inclusion and exclusion criteria. The median age was 74 (IQR: 68-77) years, the male-to-female ratio was 1.4:1, and the median forced expiratory volume in 1 s (FEV₁) at discharge was 25 (19.3-35.6)% predicted. Median survival was 158 (47-301) weeks, and Kaplan-Meier analysis demonstrated a longer survival time in males than in females (217 [77-434] vs. 130 [26-226] weeks; p = 0.036). After adjustment for age, FEV₁% and other significant sex-dependent variables, female sex remained an independent predictor of increased mortality (HR [95% CI], 2.13 [1.01-4.49]; p = 0.046). Interaction analysis confirmed improved model fit with sex-by-covariate terms (χ2 = 12.85, p = 0.045; C-index = 0.71). Higher FEV₁% was protective overall (HR [95% CI], 0.94 [0.86-0.99]; p = 0.028), but this benefit was only present in men (interaction p = 0.016). In a subgroup of patients, diffusing capacity of the lung for carbon monoxide (DLCO) data were available. Compared to males, females had lower DLCO and higher pCO₂ levels at hospital discharge, which may explain the observed sex difference in survival.</p><p><strong>Conclusion: </strong>In COPD patients released home with newly established HNIV after hospitalization for acute exacerbation with respiratory failure, even after adjustment for established clinical covariates, female sex was associated with worse survival. FEV₁% was also associated with survival; however, only in males and not in females, indicating sex-specific disease trajectories. These findings highlight the importance of incorporating sex-by-covariate interactions into prognostic models and the need for sex-tailored management strategies in advanced COPD.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-10"},"PeriodicalIF":2.6,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148449081","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":"The Alteplase Dose Assessment for Pleural Infection Therapy (ADAPT) Study-3: Efficacy and Safety of 1 mg Alteplase as a Starting Intrapleural Dose.","authors":"Estee P M Lau, Michaela Donaghy, Sam Faber, Sophie Krivinskas, Francesco Piccolo, Calvin Sidhu, Tommaso D Apos Orsogna, Sona Vekaria, Edward Fysh, Y C Gary Lee","doi":"10.1159/000553096","DOIUrl":"10.1159/000553096","url":null,"abstract":"<p><strong>Introduction: </strong>Intrapleural tissue plasminogen activator/deoxyribonuclease (tPA/DNase) therapy has revolutionised management of pleural infection. However, the optimal tPA dose is still unknown. The Alteplase Dose Assessment for Pleural infection Therapy (ADAPT) study-3 aims to evaluate the efficacy and safety of a lower starting intrapleural dose of 1 mg tPA (with 5 mg DNase) for pleural infection.</p><p><strong>Methods: </strong>Consecutive patients with pleural infection who required intrapleural fibrinolytic therapy were treated with 1 mg tPA/5 mg DNase. Escalation of tPA doses were permitted at any time at the discretion of treating physicians.</p><p><strong>Results: </strong>A total of 100 patients (22% female, mean age = 60.2) received a starting dose of intrapleural 1 mg tPA/5 mg DNase. Most (94%) patients were successfully treated and were discharged without needing surgery. Patients received a median of 5 [IQR = 3-6] doses of tPA/DNase and 6 mg of tPA [median, IQR = 3-8] in total. Treatment success was supported by improved pleural fluid drainage (from 238 mL pre-treatment to 2013 mL [IQR = 1,269-2,863] at 72 h, p < 0.0001), reduction in serum C-reactive protein levels (by 47.5% on day 5, p < 0.0001), and clearance in radiographic pleural opacities (from median 24% [IQR = 15-34] of hemithorax before tPA/DNase therapy to 10% [IQR = 7-15] 72 h after the first dose of tPA/DNase, p < 0.0001). In 28 (28%) patients, tPA dose was escalated due to minimal drainage and/or persistent sepsis; 26 were successfully treated and 2 required surgery. One (1%) patient experienced pleural bleed. Four patients with metastatic cancers were palliated during treatment for pleural infection and died.</p><p><strong>Conclusion: </strong>A starting intrapleural regimen of 1 mg tPA/5 mg DNase, with dose escalation as necessary, appears to be safe and effective for pleural infection.</p>","PeriodicalId":21048,"journal":{"name":"Respiration","volume":" ","pages":"1-9"},"PeriodicalIF":2.6,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148437606","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}