Lancet Respiratory Medicine最新文献

{"title":"Nasal high-flow oxygen for apnoeic oxygenation during emergency endotracheal intubation of children","authors":"Emma C Alexander, Padmanabhan Ramnarayan","doi":"10.1016/s2213-2600(25)00085-2","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00085-2","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"56 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoxygenation for tracheal intubation in adults who are critically ill: time to abandon the facemask?","authors":"Sheila Nainan Myatra, Samir Jaber","doi":"10.1016/s2213-2600(25)00056-6","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00056-6","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"183 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoxygenation strategies for intubation of patients who are critically ill: a systematic review and network meta-analysis of randomised trials","authors":"Tyler Pitre, Winnie Liu, Dena Zeraatkar, Jonathan D Casey, Joanna C Dionne, Kevin W Gibbs, Adit A Ginde, Natalie Needham-Nethercott, Todd W Rice, Matthew W Semler, Bram Rochwerg","doi":"10.1016/s2213-2600(25)00029-3","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00029-3","url":null,"abstract":"<h3>Background</h3>Preoxygenation is a crucial preparatory step for intubation. Several strategies for preoxygenation exist, including facemask oxygen, high-flow nasal cannula (HFNC), and non-invasive positive pressure ventilation (NIPPV). However, the comparative efficacy of these strategies remains largely uncertain. We aimed to compare the efficacy and safety of HFNC, NIPPV, and facemask oxygen for preoxygenation of patients who are critically ill requiring tracheal intubation.<h3>Methods</h3>In this systematic review and network meta-analysis, we searched Embase, MEDLINE, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials for randomised clinical trials published from database inception until Oct 31, 2024, with no language restrictions. We included randomised controlled trials that compared HFNC versus NIPPV, HFNC versus facemask oxygen, or NIPPV versus facemask oxygen in adult patients (age ≥18 years) who were critically ill requiring intubation in the intensive care or emergency department setting. We had no additional eligibility criteria for our network meta-analysis. We used Covidence software to screen eligible trials. Two reviewers independently screened trials for titles and abstracts, and then subsequently screened full-text reports. Discrepancies were resolved by discussion or a third party adjudicator. Summary-level data were extracted manually using a structured data collection form. Outcomes of interest were hypoxaemia during intubation, successful intubation on the first attempt, serious adverse events, and all-cause mortality. We performed a frequentist random-effects network meta-analysis. We assessed the risk of bias using the modified Cochrane tool (RoB 2.0) and the certainty of evidence using the GRADE approach. The protocol is registered on the Open Science Framework.<h3>Findings</h3>We initially identified 6900 records, of which 48 were assessed via full-text screening, and 15 eligible studies with 3420 patients were included in our systematic review and network meta-analysis. Findings suggested that use of NIPPV for preoxygenation probably reduces the incidence of hypoxaemia during intubation versus HFNC (relative risk 0·73 [95% CI 0·55–0·98]; p=0·032; moderate certainty) and reduces the incidence of hypoxaemia versus facemask oxygen (0·51 [0·39–0·65]; p<0·0001; high certainty). HFNC for preoxygenation reduces the incidence of hypoxaemia during intubation versus facemask oxygen (0·69 [0·54–0·88]; p=0·0064; high certainty). None of the preoxygenation strategies affected the incidence of successful intubation on the first attempt (all low certainty). None of the preoxygenation strategies appeared to affect all-cause mortality (very low-to-moderate certainty). NIPPV probably reduces the risk of serious adverse events versus facemask oxygen (0·30 [0·12–0·77]; p=0·011; moderate certainty) and might reduce the risk of serious adverse events versus HFNC (0·32 [0·11–0·91]; p=0·035; low certainty). HFNC ","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"21 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143666077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The bidirectional complexity of multiple long-term conditions and post-COVID-19 condition","authors":"Kamlesh Khunti, Rachael A Evans, Amitava Banerjee, Christina van der Feltz-Cornelis","doi":"10.1016/s2213-2600(25)00047-5","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00047-5","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"22 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive airway pressure therapy and all‐cause and cardiovascular mortality in people with obstructive sleep apnoea: a systematic review and meta-analysis of randomised controlled trials and confounder-adjusted, non-randomised controlled studies","authors":"Adam V Benjafield, Jean-Louis Pepin, Peter A Cistulli, Alison Wimms, Florent Lavergne, Fatima H Sert Kuniyoshi, Sibyl H Munson, Brendan Schuler, Shrikar Reddy Badikol, Kelly C Wolfe, Leslee Willes, Colleen Kelly, Tetyana Kendzerska, Dayna A Johnson, Raphael Heinzer, Chi-Hang Lee, Atul Malhotra","doi":"10.1016/s2213-2600(25)00002-5","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00002-5","url":null,"abstract":"<h3>Background</h3>Data regarding the effect of positive airway pressure (PAP) therapy for obstructive sleep apnoea (OSA) on all-cause mortality are inconsistent. We aimed to conduct a systematic review and meta-analysis to test the hypothesis that PAP therapy is associated with reduced all-cause and cardiovascular mortality in people with OSA.<h3>Methods</h3>For this systematic review and meta-analysis, we searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials, from database inception to Aug 22, 2023 (updated Sept 9, 2024), with no language or geographical restrictions. Reference lists of eligible studies and recent conference abstracts (2022–23) were also reviewed. We included outpatient studies (randomised controlled trials [RCTs] or confounder-adjusted, non-randomised controlled studies [NRCSs]) assessing the incidence of all-cause mortality, cardiovascular mortality, or both in adults (aged ≥18 years) with OSA who were treated versus not treated with PAP; other study types and studies that evaluated only PAP adherence were excluded. Abstracts of all retrieved publications were independently screened by two of three researchers (BS, SRB, and KCW), with disagreements resolved by adjudication from another researcher (SHM). The AutoLit feature of the Nested Knowledge platform was used for the review and data-extraction phases. We analysed each log-transformed hazard ratio (HR) and SE using a linear random-effects model to estimate overall HRs and 95% CIs. To evaluate the risk of bias, we used the Cochrane Risk of Bias tool for RCTs and the Newcastle–Ottawa Scale for NRCSs. This study was registered with PROSPERO, CRD42023456627.<h3>Findings</h3>Of 5484 records identified by our search, 435 were assessed for eligibility and 30 studies were included in the systematic review and meta-analysis (ten RCTs and 20 NRCSs). These studies included 1 175 615 participants, of whom 905 224 (77%) were male and 270 391 (23%) were female (SE 1·9), with a mean age of 59·5 (SE 1·4) years and a mean follow-up of 5·1 (0·5) years. The risk of bias was low to moderate. The risk of all-cause mortality (HR 0·63, 95% CI 0·56–0·72; p&lt;0·0001) and cardiovascular mortality (0·45, 0·29–0·72; p&lt;0·0001) was significantly lower in the PAP group than in the no-PAP group, and the clinically relevant benefit of PAP therapy increased with use.<h3>Interpretation</h3>Our results are consistent with a potentially beneficial effect of PAP therapy on all-cause and cardiovascular mortality in patients with OSA. Patients should be made aware of this effect of their treatment, which could result in greater acceptance of treatment initiation and greater adherence, leading to a higher likelihood of improved outcomes.<h3>Funding</h3>ResMed.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"4 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive airway pressure and all-cause and cardiovascular mortality in people with obstructive sleep apnoea","authors":"Ye Zhang, Virend K Somers, Xiangdong Tang","doi":"10.1016/s2213-2600(25)00015-3","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00015-3","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"642 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Withdrawal of life sustaining therapies in patients with or without acute brain injury","authors":"Scott R DeBoer, Romergryko Geocadin","doi":"10.1016/s2213-2600(25)00008-6","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00008-6","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"16 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decisions to withdraw or withhold life-sustaining therapies in patients with and without acute brain injury: a secondary analysis of two prospective cohort studies","authors":"Shaurya Taran, Kuan Liu, Victoria A McCredie, Oscar Penuelas, Karen E A Burns, Fernando Frutos-Vivar, Damon C Scales, Niall D Ferguson, Jeffrey M Singh, Armaan K Malhotra, Neill K J Adhikari","doi":"10.1016/s2213-2600(24)00404-1","DOIUrl":"https://doi.org/10.1016/s2213-2600(24)00404-1","url":null,"abstract":"<h3>Background</h3>Many deaths in the intensive care unit (ICU) occur after a decision to withdraw or withhold life-sustaining therapies (WLSTs). We aimed to explore the differences in the incidence and timing of WLST between patients with and without acute brain injuries (ABIs).<h3>Methods</h3>We did a secondary analysis of two prospective, international studies that recruited patients who were invasively or non-invasively ventilated between 2004 and 2016 from 40 countries. ABI was defined as brain trauma, ischaemic stroke, intracranial haemorrhage, seizures, or meningitis–encephalitis. The comparator group included non-ABI conditions. Time to WLST was evaluated by use of cumulative incidence curves. Differences in WLST were analysed by use of multilevel logistic regression.<h3>Findings</h3>Between March 11, 2004, and Dec 17, 2016, we recruited 21 970 patients (16 791 in the WLST analysis), of whom 13 526 (61·6%) were male and 8444 (38·4%) were female and 2896 (13·2%) had ABI. WLST occurred in 2056 (12·2%) of 16 791 patients) and was more common in patients with ABI versus without (372 [17·0%] of 2191 <em>vs</em> 1684 [11·5%] of 14 600; risk difference 5·5%; 95% CI 3·8–7·1; odds ratio [OR] 2·42; 1·89–3·12). WLST decisions occurred earlier in patients with ABI versus patients without ABI (median, 4 days [IQR 2–9] versus 6 days [2–13] after ICU admission; absolute difference, 2 days; 95% CI 1–3). Findings were similar across different ABI subgroups, world regions, and cohort years. Variability among ICUs in WLST decisions for patients with ABI and patients without ABI was high (respectively, median OR, 3·04; 95% CI 2·54–3·67, and median OR 2·59; 2·38–2·78).<h3>Interpretation</h3>Our findings suggest that WLST decisions are significantly more common in patients with ABI versus patients without ABI and occur earlier in this group. The rationale for early WLST following ABI warrants further exploration, accounting for additional neurological factors that were not available in the present analysis.<h3>Funding</h3>Canadian Institutes of Health Research.","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"18 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An overview of influenza H5 vaccines","authors":"Jessica Taaffe, Shuyi Zhong, Shoshanna Goldin, Kate S Rawlings, Benjamin J Cowling, Wenqing Zhang","doi":"10.1016/s2213-2600(25)00052-9","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00052-9","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"16 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Placebo responses in clinical trials of refractory chronic cough: mechanisms, challenges, and mitigation strategies","authors":"Elena Kum, Wafa Hassan, Imran Satia","doi":"10.1016/s2213-2600(25)00018-9","DOIUrl":"https://doi.org/10.1016/s2213-2600(25)00018-9","url":null,"abstract":"No Abstract","PeriodicalId":51307,"journal":{"name":"Lancet Respiratory Medicine","volume":"56 1","pages":""},"PeriodicalIF":76.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143608383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}