Respiratory medicine最新文献

{"title":"Metformin use is associated with reduced systemic steroid courses among pediatric asthma patients with diabetes or elevated blood glucose levels","authors":"Erhan Ararat ,&nbsp;Deepa Rastogi ,&nbsp;Bradley C. Martin","doi":"10.1016/j.rmed.2025.108403","DOIUrl":"10.1016/j.rmed.2025.108403","url":null,"abstract":"<div><h3>Background</h3><div>Patients with asthma and abnormal glucose metabolism have increased asthma exacerbations, worse lung function, and higher health care utilization. Metformin, an insulin-sensitizing agent with anti-inflammatory properties, may modify these outcomes.</div></div><div><h3>Objective</h3><div>This study explored the association between metformin use and acute asthma exacerbations in children with asthma with elevated blood glucose or a type 2 diabetes diagnosis.</div></div><div><h3>Methods</h3><div>This observational study was conducted among children aged 10–17 years with asthma and evidence of type 2 diabetes, abnormal glucose, or serum glucose ≥200 mg/dL, using the Linked Network in TrinetX data. Two cohorts were constructed: a metformin treatment group and a comparison group without metformin. Groups were matched 1:1 using a propensity score algorithm on baseline characteristics. Negative binomial models were used to compare asthma-related healthcare utilizations and systemic steroid courses. Kaplan-Meier analysis using the log-rank test compared the time to-first asthma exacerbation.</div></div><div><h3>Results</h3><div>After propensity score matching, there were 536 children each in the metformin user and comparison groups. Metformin use was associated with a significantly lower rate of systemic corticosteroid courses, with a 42 % reduction compared to the comparison group (IRR = 0.58; 95 % CI: 0.40–0.85; p = 0.005). There was no difference in the median time to the first occurrence of asthma hospitalizations, ER visits, or systemic steroid courses between the metformin use and comparison group.</div></div><div><h3>Conclusion</h3><div>Metformin use was associated with a significantly lower rate of systemic corticosteroid courses, although no differences were observed in acute care utilization and in time to first asthma exacerbation.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"248 ","pages":"Article 108403"},"PeriodicalIF":3.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252090","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":"Polygenic risk score and clinical factors predict incident idiopathic pulmonary arterial hypertension","authors":"Song Hu ,&nbsp;Jiang-Shan Tan ,&nbsp;Shengsong Zhu ,&nbsp;Lu Hua ,&nbsp;Zhennan Lin ,&nbsp;Jian Zhang","doi":"10.1016/j.rmed.2025.108404","DOIUrl":"10.1016/j.rmed.2025.108404","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to develop a comprehensive prediction model integrating polygenic risk scores (PRS) and clinical factors to identify individuals at high risk for incident idiopathic pulmonary arterial hypertension (IPAH).</div></div><div><h3>Methods</h3><div>A PRS was constructed using summary statistics derived from the largest genome-wide association study for pulmonary arterial hypertension in Europeans and validated in the UK Biobank (732 cases, 458,258 controls). After excluding individuals with IPAH at baseline, 316,073 participants (316 incident IPAH patients) were split into training and testing sets (7:3). Variable selection was performed using least absolute shrinkage and selection operator in the training set, and a prediction model for incident IPAH was established using the Cox proportional hazards model.</div></div><div><h3>Results</h3><div>A gradient increase in IPAH risk estimates was observed across polygenic risk strata (<em>P</em> for trend = 0.0035). Compared with individuals with low PRS, those with high PRS had a significant 38.5 % increased risk (OR: 1.385, 95 % CI: 1.105, 1.736). Eighteen predictors were selected and included in the comprehensive prediction model, achieving C-statistics of 0.803 (95 % CI: 0.774, 0.831) and 0.785 (95 % CI: 0.734, 0.836) in the training and testing sets, respectively. Following risk stratification using the prediction model, the high‐risk group exhibited an 8.941‐fold higher risk of incident IPAH compared to the low‐risk group. Moreover, 14 of 18 independent factors of incident IPAH were further identified.</div></div><div><h3>Conclusion</h3><div>The integrated prediction model effectively identifies individuals at high risk for IPAH, facilitating early detection and personalized interventions to reduce disease risk.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"248 ","pages":"Article 108404"},"PeriodicalIF":3.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252208","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":"Navigating options for inhaled treprostinil therapy in pulmonary hypertension.","authors":"Heather Torbic, Adriano R Tonelli","doi":"10.1016/j.rmed.2025.108398","DOIUrl":"10.1016/j.rmed.2025.108398","url":null,"abstract":"","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":" ","pages":"108398"},"PeriodicalIF":3.1,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252034","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":"Oscillometry-derived ratios for assessing small airway dysfunction: Emerging indices on the horizon","authors":"Sajal De","doi":"10.1016/j.rmed.2025.108399","DOIUrl":"10.1016/j.rmed.2025.108399","url":null,"abstract":"<div><h3>Background</h3><div>Interpretation of the ratio of lung function parameters is independent of population-based reference equations. This study evaluated the diagnostic accuracy and optimal cut-off of oscillometry-derived ratios for identifying z-score–based small airway dysfunction.</div></div><div><h3>Methods</h3><div>Pre-bronchodilator oscillometry records of 2453 adults aged ≥18 years were retrospectively examined. Resmon™ Pro FULL V3 was used for oscillometry. Peripheral airway resistance ratios were calculated as (R5-19/R5) × 100, and reactance ratios were calculated as (X5/AX) × 100. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic accuracy of peripheral airway resistance and reactance ratios, using z-score thresholds of R5–19 &gt; 1.64 and X5 &lt; –1.64 as reference standards. Optimal cutoffs were identified using Youden’s index.</div></div><div><h3>Results</h3><div>The mean age of the cohort was 45.5 ± 16.3 years, and 55.2 % were male. ROC curve analysis demonstrated that the AUC for peripheral resistance was 0.98 (95 % CI, 0.98–0.99; p &lt; 0.001). The optimal cutoff value for the resistance ratio was 19.8 %, which yielded a sensitivity of 91.3 % and a specificity of 95.6 %, with corresponding positive and negative predictive values of 97.3 % and 86.5 %, respectively. The AUC of the reactance ratio was 0.91 (95 % CI: 0.90–0.92; p &lt; 0.001). The optimal cutoff for the reactance ratio was 16.2%, with a sensitivity of 76.1%, a specificity of 94.7%, and positive and negative predictive values of 96.7% and 66.3%, respectively.</div></div><div><h3>Conclusions</h3><div>This study suggests that oscillometry-derived ratios, particularly the resistance ratio, are reliable markers for detecting small airway dysfunction, independent of normative reference equations.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"248 ","pages":"Article 108399"},"PeriodicalIF":3.1,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244914","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":"Sarcopenia as a treatable trait in COPD: From mechanisms to management","authors":"Maria Gabriella Matera ,&nbsp;Clive Page ,&nbsp;Mario Cazzola","doi":"10.1016/j.rmed.2025.108401","DOIUrl":"10.1016/j.rmed.2025.108401","url":null,"abstract":"<div><div>Sarcopenia is common in COPD, with prevalence ranging from 14 % to 67 % depending on setting, age, disease severity, and nutritional status, highlighting its clinical relevance and the need for standardized diagnostic criteria and routine screening, especially in older or more severe cases. It results from a complex interplay of systemic inflammation, oxidative stress, mitochondrial dysfunction, physical inactivity, hypoxia, malnutrition, hormonal imbalances, and structural muscle remodeling, all contributing to muscle catabolism and impaired regeneration. These factors form a vicious cycle that worsens functional decline, highlighting the need for multifaceted, integrated therapeutic approaches. Sarcopenia in COPD is a measurable, modifiable, and treatable trait linked to worse lung function, physical performance, and outcomes. Early detection using the EWGSOP2 algorithm, starting with SARC-F screening, muscle strength testing, and confirmation via imaging and targeted interventions, can enable timely, effective interventions to improve outcomes. Targeted sarcopenia treatment in COPD includes pulmonary rehabilitation, nutritional support, and behavioral strategies. Exercise and high-protein, vitamin D–rich diets improve muscle strength and function. Pharmacological options remain experimental. Multidisciplinary care involving pulmonologists, physiotherapists, dietitians, and primary care providers ensures early detection, individualized treatment, and better outcomes through integrated interventions that address both respiratory impairment and muscle loss. Despite promising advances, key research gaps remain in sarcopenia as a treatable trait in COPD, including the need for standardized diagnostic criteria, longitudinal studies, optimal intervention strategies, and integration of functional outcomes. Future research should prioritize equity, mechanistic insights, and implementation science to refine personalized care and improve clinical outcomes in COPD.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"248 ","pages":"Article 108401"},"PeriodicalIF":3.1,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244883","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":"Effects of diaphragmatic manual therapy on respiratory function in patients with non-specific low back pain: A randomized control trial","authors":"Francisco José Vera-Serrano ,&nbsp;Maria Jesus Vinolo-Gil ,&nbsp;Lourdes María Fernández Seguín ,&nbsp;Juan Antonio Díaz-Mancha","doi":"10.1016/j.rmed.2025.108394","DOIUrl":"10.1016/j.rmed.2025.108394","url":null,"abstract":"<div><h3>Background</h3><div>Non-specific low back pain (NSLBP) is common and often resistant to conventional physiotherapy. The diaphragm, given its dual role in posture and respiration, may be a therapeutic target.</div></div><div><h3>Objective</h3><div>To determine whether diaphragm manual therapy plus conventional physiotherapy improves thoracic expansion and pulmonary function in NSLBP.</div></div><div><h3>Methods</h3><div>A single-blind randomized controlled trial included 46 adults with NSLBP (mean age 46.0 ± 16.2 years; 43 % female; BMI 27.2 ± 5.4 kg/m²). Participants were randomized to an experimental group (n = 20) receiving diaphragm manual therapy plus physiotherapy or a control group (n = 26) receiving physiotherapy alone. Outcomes were inspiratory thoracic expansion, forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1), measured at baseline, post-treatment, and 10- and 30-day follow-ups. Repeated-measures ANOVA and Spearman correlation were used (α = 0.05).</div></div><div><h3>Results</h3><div>The experimental group showed greater improvements in thoracic expansion (mean difference = 3.31 cm; 95 % CI 2.69–3.93; p &lt; 0.001; η² = 0.78), FVC (Δ = 1.24 L; 95 % CI 1.11–1.37; p &lt; 0.001; η² = 0.76), and FEV1 (mean difference = 1.25 L; 95 % CI 1.12–1.38; p &lt; 0.001; η² = 0.77) compared with controls. Thoracic expansion correlated with FVC (ρ = 0.731) and FEV1 (ρ = 0.751) at 30 days (both p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Diaphragm manual therapy improved thoracic expansion and pulmonary function in NSLBP, supporting its role as an adjunct to physiotherapy.</div><div>The trial has been registered under the name of “DIAFRAGMA” and number NCT06069388.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"248 ","pages":"Article 108394"},"PeriodicalIF":3.1,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233418","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":"Association of the high-density lipoprotein cholesterol to C-reactive protein ratio with pulmonary function among U.S. adults: A cross-sectional study from NHANES 2007–2010","authors":"Xue-Feng Li ,&nbsp;Mei-Ling Zhang","doi":"10.1016/j.rmed.2025.108397","DOIUrl":"10.1016/j.rmed.2025.108397","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies have shown a strong association between impaired pulmonary function and both lipid metabolic disorders and inflammatory states. However, the relationship between the high-density lipoprotein cholesterol (HDL-C) to C-reactive protein (CRP) ratio and pulmonary function remains unclear. The aim of this study was to investigate the relationship between HDL-C/CRP and pulmonary function, including forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1).</div></div><div><h3>Methods</h3><div>This cross-sectional study included 5185 participants from the National Health and Nutrition Examination Survey (NHANES, 2007–2010). The association between the HDL-C/CRP ratio and pulmonary function parameters (FVC, FEV1, and the FEV1/FVC ratio) was assessed using multivariable linear regression models adjusted for potential confounders. Nonlinear associations were explored with smoothed curve fitting. Subgroup and sensitivity analyses were performed to evaluate the robustness of the associations.</div></div><div><h3>Results</h3><div>Our study showed that the natural logarithm of the HDL-C/CRP ratio, Ln(HDL-C/CRP), both as a continuous variable and as a categorical variable (tertiles), was linearly and positively correlated with pulmonary function parameters (FVC and FEV1). However, no statistically significant correlation was shown between FEV1/FVC and Ln(HDL-C/CRP). Subsequent subgroup and sensitivity analyses further confirmed the significant associations between lung function parameters (FEV1 and FVC) and the Ln(HDL-C/CRP), and validated the robustness and reliability of the results.</div></div><div><h3>Conclusions</h3><div>This cross-sectional study found that elevated HDL-C/CRP ratios are positively related to pulmonary function parameters (FVC and FEV1) among U.S. adults. Additionally, this suggested that HDL-C/CRP ratio may serve as an indicator for assessing improvements in these parameters.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"248 ","pages":"Article 108397"},"PeriodicalIF":3.1,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239482","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":"Pathological features of pulmonary vasculopathy in interstitial lung disease-associated pulmonary hypertension.","authors":"Ayako Igarashi-Sugimoto, Ichizo Tsujino, Hideki Shima, Junichi Nakamura, Toshitaka Nakaya, Takahiro Sato, Taku Watanabe, Hiroshi Ohira, Kei Takamura, Noriyuki Otsuka, Akihiro Ishizu, Sari Iwasaki, Zenichi Tanei, Mishie Tanino, Koji Taniguchi, Shinya Tanaka, Isao Yokota, Satoshi Konno","doi":"10.1016/j.rmed.2025.108395","DOIUrl":"https://doi.org/10.1016/j.rmed.2025.108395","url":null,"abstract":"<p><strong>Background: </strong>The prognosis of interstitial lung disease-associated pulmonary hypertension remains poor, and the characteristics of the vasculopathy and its underlying pathogenesis are unclear.</p><p><strong>Objective: </strong>To investigate the pathological characteristics of pulmonary vasculopathy in interstitial lung disease-associated pulmonary hypertension.</p><p><strong>Methods: </strong>Autopsy specimens were collected from four groups: control (n=2), pulmonary arterial hypertension (n=3), interstitial lung disease-associated pulmonary hypertension (n=6), and interstitial lung disease without pulmonary hypertension (n=3). The morphology from the arteries to the veins was quantitively compared, along with the expression of pathogenetic factors and target proteins of pulmonary vasodilators.</p><p><strong>Results: </strong>The percent area stenosis of the muscular arteries and veins were 83% (71%-92%) and 54% (41%-70%), respectively, in the interstitial lung disease-associated pulmonary hypertension group, which were not significantly different compared with other groups except controls. In contrast, for microvessels, the percent area stenosis and muscularization rate in moderate fibrotic areas were significantly higher, and capillary multilayering was also more prominent, in the interstitial lung disease-associated pulmonary hypertension group compared with the interstitial lung disease without pulmonary hypertension group. The expression of pathogenetic factors was not different between interstitial lung disease groups with and without pulmonary hypertension; however, prostaglandin I2 receptors were more strongly expressed in the microvessel wall of interstitial lung disease-associated pulmonary hypertension group than in pulmonary arterial hypertension group.</p><p><strong>Conclusions: </strong>Interstitial lung disease-associated pulmonary hypertension is pathologically characterized by microvessel remodeling and capillary multilayering. Increased expression of prostaglandin I2 receptor in the microvessels suggests different responses to stimulators of the pathway.</p>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":" ","pages":"108395"},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233512","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":"Anti-inflammatory agents for the management of COPD - Quo Vadis?","authors":"Agamemnon Bakakos ,&nbsp;Zoi Sotiropoulou ,&nbsp;Nektarios Anagnostopoulos ,&nbsp;Angelos Vontetsianos ,&nbsp;Kyriaki Cholidou ,&nbsp;Andriana I. Papaioannou ,&nbsp;Konstantinos Bartziokas","doi":"10.1016/j.rmed.2025.108396","DOIUrl":"10.1016/j.rmed.2025.108396","url":null,"abstract":"<div><div>Chronic obstructive pulmonary disease (COPD) remains a leading cause of morbidity and mortality around the globe. Its main characteristics are persistent respiratory symptoms and progressive airflow limitation, both of which are driven by chronic inflammation. Despite the use of maximum bronchodilation and in selected patients inhaled corticosteroids (ICS), current therapies neither halt disease progression nor prevent exacerbations and loss of lung function.</div><div>Recent research has focused on developing novel anti-inflammatory agents targeting specific pathways implicated in COPD pathogenesis, aiming to provide disease-modifying effects beyond symptomatic relief. Among these, inhaled phosphodiesterase 4 (PDE4) inhibitors and especially dual PDE3/4 inhibitors like ensifentrine have demonstrated promising anti-inflammatory and bronchodilator effects, with ensifentrine recently being added in our arsenal of treatment options. Additionally, biologic therapies targeting type 2 inflammation, particularly monoclonal antibodies (mAbs) focusing on interleukin-5 (IL-5) and interleukin-4/13 (IL-4/13) pathways have shown efficacy in reducing exacerbations in patients with eosinophilic COPD. Dupilumab, a mAb targeting IL-4/13, is the first biologic officially approved for COPD.</div><div>Other strategies under investigation include Janus kinase (JAK) and mitogen-activated protein kinase (MAPK) inhibitors, chemokine receptor antagonists and agents targeting products of inflammatory cells such as matrix metalloproteinases (MMPs) and neutrophil elastase. While some novel compounds have failed to demonstrate clinical benefit or were discontinued due to futility, the constantly evolving therapeutic landscape highlights the importance of a personalized approach, based on inflammatory phenotypes. Ongoing and future trials could elucidate the role of these innovative agents in improving outcomes for COPD patients and may reshape standard management paradigms.</div></div>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":"248 ","pages":"Article 108396"},"PeriodicalIF":3.1,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233407","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 effect of kidney replacement therapy on lung mechanics and respiratory function: A systematic review and meta-analysis.","authors":"Subhash Chander, Fnu Sorath, Ahmad Bin Aamir, Abhi Chand Lohana, Hong Yu Wang, Nadeem Yaqub Mohammed, Renata Mendes, Patricia R M Rocco","doi":"10.1016/j.rmed.2025.108291","DOIUrl":"10.1016/j.rmed.2025.108291","url":null,"abstract":"<p><strong>Background: </strong>Given the substantial overlap between renal and pulmonary systems, understanding the role of kidney replacement therapy (KRT) in alleviating respiratory complications is essential for managing patients with concurrent kidney and lung dysfunction. This study evaluated the impact of KRT, including hemodialysis and peritoneal dialysis, on lung mechanics and respiratory function, especially in critically ill patients on mechanical ventilation.</p><p><strong>Methods: </strong>PubMed, Cochrane, Scopus, and Web of Science were searched up to October 8, 2024. Studies were selected using prespecified criteria and analyzed using R. Heterogeneity was assessed with the I² test; study quality was evaluated using ROBINS-IV2. This project is registered in PROSPERO with ID CRD420251106970.</p><p><strong>Results: </strong>Seven studies (10 cohorts, 436 patients; 59.4 % male; mean age 49.5-73.2) were included. KRT significantly improved static lung compliance (MD 10.34; 95 % CI 5.46-15.41; p < 0.01), especially with PD in ICU patients (MD 17.20; 95 % CI 10.54-23.86; p < 0.01). No significant effects were found on dynamic compliance, respiratory resistance, or most pulmonary indices. Oxygenation showed a borderline improvement (MD 41.20; 95 % CI 0.62-81.78; p = 0.05).</p><p><strong>Conclusion: </strong>This review highlights the potential benefits of KRT in improving static lung compliance in ICU patients, especially with PD. However, improvements in oxygenation efficiency remain limited and inconsistent, likely due to the complexities of critical care factors. The lack of adequate reporting on potential mediators of KRT's impact on pulmonary function prevents us from drawing firm conclusions.</p>","PeriodicalId":21057,"journal":{"name":"Respiratory medicine","volume":" ","pages":"108291"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785159","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}