BMC Pulmonary Medicine最新文献

{"title":"Impact of patient positioning on the efficacy and safety of doxycycline pleurodesis in malignant pleural effusion: a pilot randomized trial.","authors":"Hieba Gamal Ezzelregal, Ahmed Mohamed Abdelsamad","doi":"10.1186/s12890-026-04630-3","DOIUrl":"10.1186/s12890-026-04630-3","url":null,"abstract":"<p><strong>Background: </strong>Chemical pleurodesis is a standard palliative intervention for recurrent malignant pleural effusion (MPE). Historically, patient rotation after sclerosant instillation was routine to ensure uniform drug distribution, but evidence supporting this practice remains conflicting. The study question was, does doxycycline pleurodesis without patient rotation demonstrate comparable efficacy and safety to the standard rotation protocol?</p><p><strong>Methods: </strong>This pilot randomized trial included 40 patients with recurrent MPE eligible for pleurodesis. Patients were randomized (1:1) to either a Rotation group (n = 20), which underwent a 2-h sequential rotation, or a Non-Rotation group (n = 20), which remained supine. The primary outcome was pleurodesis success at 1 month, assessed by chest ultrasonography. The secondary outcome was the Pleural Adherence Score (PAS) to objectively assess drug distribution and pain assessment.</p><p><strong>Results: </strong>The mean age was 56.5 years. Pleurodesis success rates were identical between the rotation and non-rotation groups 85% (17/20) vs. 85% (17/20); P > 0.99, though the confidence interval was wide (- 22.13% to 22.13%). Crucially, ultrasound-derived PAS scores at day 1 were high and comparable between groups (Mean 20.0 vs. 21.2; P = 0.33), confirming effective sclerosant distribution without rotation. There were no significant differences in pain scores, drainage duration, or complication rates between the two groups.</p><p><strong>Conclusion: </strong>Omitting patient rotation during doxycycline pleurodesis for MPE demonstrated comparable 1-month efficacy in this pilot study, though larger trials are needed to establish definitive equivalence. These findings support a simplified non-rotation protocol to reduce patient burden.</p><p><strong>Trial registration: </strong>The trial was retrospectively registered at ClinicalTrials.gov (Identifier: NCT07147270).</p><p><strong>Clinicaltrials: </strong>gov PRS: Home page (Modernized) published 08/29/2025.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13527988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863364","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":"Isolated, reduced diffusing capacity for carbon monoxide in the population - relations to symptoms, smoking and comorbidities.","authors":"Viktor Hamrefors, Johan Westerbergh, Annelie Behndig, Anders Blomberg, John Brandberg, Anna Carlén, Arne Egesten, Emil Ekbom, Össur Ingi Emilsson, Maria J Eriksson, Andreas Frølich, Ludger Grote, Christer Janson, Reza Karimi, Anna Moberg, Hans Lennart Persson, Ida Pesonen, Magnus Sköld, Karen Sörensen, Hanan Tanash, Kjell Torén, Lowie Vanfleteren, Per Wollmer, Andrei Malinovschi","doi":"10.1186/s12890-026-04662-9","DOIUrl":"10.1186/s12890-026-04662-9","url":null,"abstract":"<p><strong>Background: </strong>Diffusing capacity for carbon monoxide (D_LCO) is a measure of gas exchange in the lungs. Reduced D_LCO with normal spirometry is a common finding that is incompletely understood.</p><p><strong>Aim: </strong>To assess determinants of isolated, reduced D_LCO in an unselected population.</p><p><strong>Methods: </strong>The Swedish CArdioPulmonary bioImage Study (SCAPIS) is a multicentre population-based study of adults aged 50-64 years. The 5th percentile of D_LCO in healthy never smokers was used as the lower limit of normal (LLN). Using multivariable analysis, we studied factors associated with D_LCO < LLN in 24 261 subjects with normal spirometry, defined as FEV1, FVC and FEV1/FVC > LLN. Emphysema and interstitial lung abnormalities (ILA) were assessed through computed tomography, physical activity through accelerometry and other factors through questionnaires.</p><p><strong>Results: </strong>Isolated D_LCO < LLN (n = 1 472) was independently associated with emphysema (odds ratio and 95% confidence interval: 2.6 (2.2, 3.2)), lung disease other than asthma or COPD (1.8 (1.2, 2.8)), exertional chest pain (1.6 (1.3, 2.1)), smoking (per-10-pack-years) (1.6 (1.4, 1.9)), ILA (1.4 (1.2, 1.7)), breathing problems (1.4 (1.1, 1.8)), male sex (1.3 (1.1, 1.6)) and coughing (1.2 (1.1, 1.5)). D_LCO < LLN was less likely if subjects were older, had asthma or had higher BMI, haemoglobin, FVC or physical activity.</p><p><strong>Conclusion: </strong>Isolated, reduced D_LCO in a large middle-aged population cohort is associated with numerous previously known factors, including emphysema, ILA, smoking and self-reported lung disease. However, several symptoms, including exertional chest pain, breathing problems and coughing, are also independently associated with isolated reduced D_LCO.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863302","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":"Beyond injury severity: monocyte-associated small extracellular vesicles distinguish respiratory-support trajectories following thoracic trauma.","authors":"Aliona Wöhler, Arnulf G Willms, Andreas Scholz, Nina Kühler, Robert Schwab, Paula Müller, Miroslaw T Kornek","doi":"10.1186/s12890-026-04653-w","DOIUrl":"10.1186/s12890-026-04653-w","url":null,"abstract":"<p><p>Thoracic trauma is a major contributor to morbidity in severely injured patients and is frequently associated with prolonged mechanical ventilation, tracheostomy, and extended intensive care unit (ICU) treatment. Early identification of patients at risk for unfavorable respiratory-support trajectories remains challenging. Small extracellular vesicles (sEVs) are rapidly released in response to cellular activation and injury and may provide biological information complementary to established clinical parameters. In our study we analyzed CD9⁺CD14⁺ and CD9⁺CD61⁺ sEV subpopulations in 45 patients with thoracic trauma. sEV levels were quantified within 24 h after admission and evaluated in relation to clinically relevant respiratory-support trajectories, including the predefined primary respiratory-support endpoints of tracheostomy and prolonged mechanical ventilation (> 5 days). Prolonged ICU stay (> 5 days) was analyzed as a supportive endpoint reflecting overall intensive-care burden. Predictive performance was assessed using repeated cross-validated receiver operating characteristic (ROC) analysis and compared with predefined clinical injury, laboratory, and oxygenation-based models. Residual analyses were performed to determine whether EV-associated information extended beyond established thoracic injury severity scores. CD9⁺CD14⁺ sEVs represented the dominant EV signal and were significantly elevated in patients requiring tracheostomy (3.84-fold, p = 0.009), prolonged mechanical ventilation > 5 days (4.88-fold, p = 0.003), and prolonged ICU treatment > 5 days (5.62-fold, p = 0.003). Within this exploratory cohort, CD9⁺CD14⁺ sEVs demonstrated performance comparable to the clinical injury model and consistently performed significantly better than laboratory- and oxygenation-based approaches across multiple respiratory-support trajectory endpoints. Sensitivity analyses using stricter thresholds (> 10 days) yielded similar findings. Residual analyses further demonstrated that patients with higher-than-expected CD9⁺CD14⁺ levels relative to AIS Chest and TTSS exhibited increased rates of tracheostomy and prolonged mechanical ventilation, suggesting that EV-associated information is not fully explained by anatomical injury severity alone. We concluded that early CD9⁺CD14⁺ sEV levels are associated with unfavorable respiratory-support trajectories following thoracic trauma. While established injury scores primarily describe the extent of anatomical damage, EV-associated biomarkers may provide complementary information regarding the biological response to injury. These findings support further investigation of EV-based biomarkers as tools for early risk stratification in thoracic trauma and warrant validation in larger independent cohorts.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863222","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":"Impact of CPAP and ventilator system resistance on respiratory effort in healthy volunteers.","authors":"Simon Lindner, Lena Doerflinger, Luisa S Drotleff, Burcu Link, Benjamin Neetz, Julia D Michels-Zetsche, Felix J F Herth, Daniel Duerschmied, Simone Britsch","doi":"10.1186/s12890-026-04649-6","DOIUrl":"10.1186/s12890-026-04649-6","url":null,"abstract":"<p><strong>Introduction: </strong>Continuous positive airway pressure (CPAP) is widely used for the treatment of acute and chronic respiratory failure and inspiratory support pressure (ΔP_insp) can be added to achieve non-invasive ventilation (NIV). We performed a physiological study to determine the effect of CPAP and inspiratory support pressure on respiratory effort measured by esophageal tidal swings in healthy volunteers.</p><p><strong>Methods: </strong>Esophageal tidal swings were measured in spontaneously breathing, healthy volunteers undergoing 4 airway pressure conditions: atmospheric pressure (A), on a ventilator without any applied pressures (V), CPAP of 5 cmH₂O, and NIV with PEEP of 5 cmH₂O and ΔP_insp of 5 cmH₂O during rest, light, and strenuous exercise. The sequence of airway conditions was randomized and the investigator reading the esophageal pressures was blinded.</p><p><strong>Results: </strong>Thirty-eight individuals were included in the analysis. Esophageal tidal swing during rest was highest when CPAP was applied, compared to A and NIV. During light and strenuous exercise, both V and CPAP increased respiratory effort, compared to A and NIV, suggesting an increase in ventilator system resistance at higher minute ventilation.</p><p><strong>Conclusion: </strong>CPAP increased respiratory effort compared to both NIV and breathing at atmospheric pressure, but ventilator system resistance appeared to be a more relevant determinant of respiratory effort at higher minute ventilation induced by exercise. As acute respiratory failure often is associated with high minute ventilation, further studies are needed to examine the potential clinical implications of these findings.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148856909","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":"Rapid recovery from near-fatal immune reconstitution inflammatory syndrome and acute respiratory distress syndrome following neutropenic recovery by cytokine adsorption.","authors":"Karl Bihlmaier, Laura Vonbrunn, Axel Schmid, Larissa Herbst, Krystyna Bujok, Felix A Büstgens, Rebecca Wätzig, Heidi Waibel, Mario Schiffer, Carsten Willam","doi":"10.1186/s12890-026-04619-y","DOIUrl":"10.1186/s12890-026-04619-y","url":null,"abstract":"<p><strong>Background: </strong>In the presence of clinical or microbiological evidence of pneumonia, emerging leukocytes in recovery from neutropenia undergo substantial migration to the site of infection, where they elicit immunogenic reactions. The administration of granulocyte colony-stimulating factors is a risk factor for dysregulation of this immune response, which can lead to ARDS. However, there is a paucity of knowledge regarding the severe forms of near-fatal IRIS.</p><p><strong>Case presentation: </strong>This case report describes the successful treatment of a hematologic patient with life-threatening Immune Reconstitution Inflammatory Syndrome after recovery from neutropenia and a subsequent acute respiratory distress syndrome involving cytokine adsorption. The present report delineates the case of a 65-year-old male afflicted with plasmoblastic lymphoma and neutropenic sepsis with pneumonia. Escherichia coli was identified in bronchoalveolar lavage fluids, and the patient was successfully treated with piperacillin and tazobactam. After recovering from neutropenia, the patient's respiratory function abruptly worsened, resulting in a secondary, severe ARDS. This deterioration was accompanied by increasing interleukin-6 levels. Therapeutic approaches as prone positioning or volume depletion using renal replacement therapy with high ultrafiltration rates did not lead to a significant respiratory improvement. Initiation of cytokine adsorption resulted in an immediate and absolute respiratory recovery.</p><p><strong>Conclusions: </strong>Immune reconstitution inflammatory syndrome might cause dysregulated pulmonary immune responses following recovery from neutropenia with consecutive severe ARDS. This case report is the first to link IRIS-induced severe ARDS to a hyperinflammatory condition and to the successful therapeutic approach of cytokine adsorption. Ultimately, only cytokine adsorption was able to rapidly improve this suspected IRIS-associated hyperinflammation in an otherwise life-threatening ARDS.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825275","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":"Subclinical hyperthyroidism is associated with reduced spirometric parameters in asymptomatic adults: a cross-sectional observational study with etiology-stratified analysis.","authors":"Berçem Afşar Karatepe, Burcu Özgür Çil, Zuhal Karaca Karagöz, Gülşah Altun, Derya Hoşgün","doi":"10.1186/s12890-026-04590-8","DOIUrl":"10.1186/s12890-026-04590-8","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The pulmonary effects of subclinical hyperthyroidism (SH) remain incompletely understood, and previous studies have been limited by reliance on absolute spirometric values, absence of etiology stratification, and inadequate control for anthropometric confounders. This cross-sectional study evaluated whether biochemically confirmed SH is independently associated with reduced spirometric parameters in asymptomatic adults, and whether these associations differ by SH etiology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 148 outpatients aged 18-65 years were enrolled: 101 with confirmed SH (TSH &lt; 0.4 mIU/L on two independent measurements ≥3 months apart, with normal fT4 and fT3) and 47 euthyroid controls (TSH 0.4-4.0 mIU/L). Individuals with pulmonary disease, cardiovascular disease, neuromuscular disorders, smoking history, or recent respiratory infection were excluded. Spirometry was performed according to ATS/ERS 2019 standards and results expressed as percent predicted (%pred) using European Community for Steel and Coal (ECSC) 1993 reference equations. To address demographic imbalances, a 1:1 age- and sex-matched sensitivity analysis (n = 34 per group) was performed. Multivariate linear regression controlled for age, sex, BMI, and height. SH etiology (Graves' disease, toxic multinodular goiter [TMNG], autonomous nodule, exogenous) and TSH suppression grade (Grade 1: 0.1-0.4 mIU/L; Grade 2: &lt;0.1 mIU/L) were recorded RESULTS: In the full study population, SH was associated with significantly lower FVC%pred (90.2 ± 22.9 vs. 104.9 ± 16.0, p &lt; 0.001), FEV₁%pred (p &lt; 0.001), PEF%pred (p = 0.004), and FEF₂₅-₇₅%pred (p = 0.006). The FEV₁/FVC ratio did not differ between groups (p = 0.670). A restrictive spirometric pattern was more prevalent in SH patients than controls (19% vs. 4%, p = 0.035). In the matched sample, FVC%pred (97.8 ± 15.6 vs. 106.8 ± 15.2, p = 0.018) and FEV₁%pred (95.4 ± 16.2 vs. 103.2 ± 15.8, p = 0.049) remained significantly lower. Multivariate regression confirmed SH as an independent correlate of lower FVC%pred (β = -7.09, 95% CI: -14.17 to -0.02, p = 0.049). Etiology-stratified analysis revealed that spirometric impairment was driven primarily by TMNG (FVC%pred 85.0 vs. 104.2 in controls, p &lt; 0.001; FEV₁%pred 78.5 vs. 103.0 in controls, p &lt; 0.001), whereas Graves' disease and autonomous nodule patients did not differ significantly from controls. Confirmatory TSH measurements demonstrated high temporal consistency (Spearman p = 0.960, p &lt; 0.001), with 99/101 patients classified as persistent SH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this cross-sectional study, confirmed SH was independently associated with modest but statistically significant reductions in spirometric parameters, with the impairment concentrated in patients with TMNG etiology. As causal inference is not possible from a cross-sectional design, these findings should be regarded as hypothesis-generating. They support etiology-specific res","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147716","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":"Prediction models for dynamic respiratory muscle strength in COPD and asthma patients based on fixed-pressure inspiratory muscle performance.","authors":"Yasemin Ari Yilmaz, Mehmet Ismail Tosun, Erkan Demirkan, Meryem Yalcinkaya, Abdulsamet Efdal, Hilal Boyacı, Hazel Kara Gunaydin, Mustafa Arici, Mert Ayranci, Milan Marković","doi":"10.1186/s12890-026-04579-3","DOIUrl":"https://doi.org/10.1186/s12890-026-04579-3","url":null,"abstract":"<p><strong>Background: </strong>Dynamic inspiratory muscle strength, assessed using the S-Index, reflects pressure generation during flow-dependent inspiration and may provide functional information beyond static respiratory muscle strength measures. However, its routine clinical use is limited by the need for specialized equipment. This study aimed to develop and internally validate prediction models for estimating S-Index from accessible pulmonary function, body composition, and fixed-pressure inspiratory performance measures in male patients with chronic obstructive pulmonary disease (COPD) or asthma.</p><p><strong>Methods: </strong>In this cross-sectional predictive modeling study, 123 male patients with COPD or asthma underwent S-Index assessment using a single-breath test. Demographic characteristics, body composition, spirometry variables, and inspiratory performance data from a fixed-pressure task-to-failure protocol at 30 cmH₂O were evaluated as candidate predictors. Linear, regularized, robust, support vector, quantile, and multilayer perceptron regression models were developed. Missing spirometry values were handled using 20 multiply imputed datasets. Model performance was evaluated using repeated nested five-fold cross-validation with 10 repetitions and assessed using mean squared error (MSE), root mean squared error (RMSE), mean absolute error (MAE), and coefficient of determination (R²), with bootstrap-derived 95% confidence intervals.</p><p><strong>Results: </strong>Peak inspiratory flow rate and the number of inspiratory repetitions showed the strongest correlations with S-Index (r = 0.83 and r = 0.70, respectively). In the full predictor scenario, regularized and linear regression models showed broadly comparable internal predictive performance. LassoLars numerically achieved the lowest prediction error, with an RMSE of 7.156 cmH₂O (95% CI: 6.108-8.285), MAE of 5.538 cmH₂O (95% CI: 4.778-6.352), and R² of 0.758 (95% CI: 0.651-0.829). Lasso and Elastic Net produced similar results. Models using only demographic, anthropometric, and body composition variables explained approximately 44-46% of the variance, whereas adding spirometry and inspiratory flow variables increased explained variance to approximately 70%. Complete-case sensitivity analysis yielded broadly consistent findings.</p><p><strong>Conclusions: </strong>In this pooled single-center cohort of male patients with COPD or asthma, S-Index could be estimated with useful internal predictive performance from fixed-pressure inspiratory performance, spirometry, and body composition variables. These models should be interpreted as complementary to, rather than substitutes for, direct S-Index measurement. External validation is required before clinical implementation.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788190","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":"Quality of life instruments in idiopathic pulmonary fibrosis: a COSMIN-based systematic review.","authors":"Enming Zhang, Jianmei Gong, Shi Wang, Yu Duan, Shuangying Ma, Haifeng Cheng","doi":"10.1186/s12890-026-04550-2","DOIUrl":"10.1186/s12890-026-04550-2","url":null,"abstract":"<p><strong>Objective: </strong>This systematic review aims to systematically evaluate the methodological quality and measurement properties of existing quality-of-life assessment tools for patients with idiopathic pulmonary fibrosis, and to provide evidence-based recommendations for instrument selection in clinical research and practice.</p><p><strong>Methods: </strong>A comprehensive computer search was conducted in PubMed, Embase, Web of Science, CINAHL, CNKI, Wanfang, VIP, and the Chinese Biomedical Literature Database from January 1, 2010 to December 28, 2025. Studies evaluating the measurement properties of IPF-specific quality of life tools published in Chinese or English were included. Two researchers independently screened the literature and extracted data, while four researchers assessed the methodological quality and measurement properties of the included studies according to the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines.The modified Grading of Recommendations Assessment Development and Evaluation (GRADE) method was employed to grade the certainty of evidence, and based on this grading along with team consensus, recommendations were formulated.</p><p><strong>Results: </strong>A preliminary search identified 1923 records (6 Chinese, 1917 English). After removing duplicates, 910 records remained; 840 were excluded by title and abstract screening, and the remaining 70 full texts were assessed. Ultimately, 11 documents were included, encompassing 9 assessment tools. The evaluation of methodological quality revealed that most tools had methodological shortcomings, particularly in content validity, cross‑cultural validity, measurement error, and criterion validity. Following the evidence grading, none of the nine tools met the standards for Category A recommendations; all were classified as Category B recommendations. Notably, the IPF-PRO scale demonstrated higher evidence quality in terms of internal consistency, structural validity, hypothesis testing, and other measurement attributes, leading to its provisional recommendation for use.</p><p><strong>Conclusion: </strong>The IPF-PRO scale demonstrates high methodological quality in its validation study for structural validity and internal consistency, with the evidence for these properties graded as \"High\" by the modified GRADE approach. However, its structural validity results were rated as \"indeterminate\" by COSMIN criteria, indicating that the statistical findings did not fully meet the criteria for \"sufficient\" evidence. Content validity was graded as \"Moderate\" and criterion validity as \"Low\". Therefore, while the IPF-PRO scale shows promise and is provisionally recommended for use in Chinese clinical settings with appropriate caveats, further validation is needed to confirm its structural validity and to evaluate its measurement error and responsiveness.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13540806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886554","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":"Impact of pre-tracheostomy continuous enteral feeding on aspiration pneumonia risk and clinical outcomes: a prospective observational study.","authors":"Serpil Ekin, Derful Gülen, İlkay Ceylan, Buket Özyaprak, Hamide Ayben Korkmaz, Nermin Kılıçarslan","doi":"10.1186/s12890-026-04548-w","DOIUrl":"10.1186/s12890-026-04548-w","url":null,"abstract":"<p><strong>Purpose: </strong>The optimal management of enteral nutrition before tracheostomy in mechanically ventilated patients in the intensive care unit (ICU) remains uncertain, and pre-procedural fasting is widely practiced in clinical settings to reduce the risk of aspiration. However, interruption of enteral nutrition (EN) may adversely affect metabolic stability and caloric intake in critically ill patients. This study aimed to prospectively evaluate whether continuation of EN before tracheostomy increases aspiration risk or influences clinical outcomes in mechanically ventilated ICU patients.</p><p><strong>Patients and methods: </strong>This prospective observational study was conducted in the anesthesiology and resuscitation intensive care units of a tertiary care center. Adult mechanically ventilated patients scheduled for elective percutaneous tracheostomy were included. Patients were divided into two groups according to the enteral nutrition strategy applied before the procedure: the continuous feeding group and the fasting group. The primary endpoint was the incidence of aspiration pneumonia within 72 h after tracheostomy. Secondary endpoints included respiratory parameters, arterial blood gas measurements, delta (Δ) changes in physiological variables, procedure-related complications, and ICU and hospital outcomes.</p><p><strong>Results: </strong>A total of 110 patients were assessed for eligibility, and 91 patients were included in the final analysis (continuous feeding group n = 45; fasting group n = 46). Baseline demographic characteristics, disease severity scores, and pre-tracheostomy respiratory parameters were comparable between groups. The incidence of aspiration pneumonia was 6.7% in the continuous feeding group and 4.4% in the fasting group, corresponding to an absolute risk difference of 2.3% (95% CI, - 6.6 to 11.2) and a crude odds ratio of 1.57 (95% CI, 0.25-9.88). Post-tracheostomy FiO₂ requirements were higher in the fasting group (p = 0.005), while other respiratory and arterial blood gas parameters were similar. Delta analyses showed greater increases in PaO₂ and more stable lactate levels in the continuous feeding group (p = 0.024 and p = 0.033). ICU and hospital length of stay, complication rates, and mortality were comparable.</p><p><strong>Conclusions: </strong>Continuation of EN before tracheostomy with passive nasogastric drainage was not associated with a statistically significant increase in aspiration pneumonia or adverse outcomes compared with conventional fasting. However, the small number of events and wide confidence intervals indicate that clinically relevant differences cannot be excluded. Larger, adequately powered studies are needed to confirm safety and clarify the clinical implications of pre-tracheostomy feeding strategies.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov, NCT07508293. Registered on March 21, 2026, retrospectively registered.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103975","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":"Lung ultrasound in UIP and NSIP: clinical and functional associations.","authors":"Ge Du, Min Li, Dongxia Hao, Min Cao, Jiali Wang, Huiying Feng, Dongchang Wang, Huan Ye","doi":"10.1186/s12890-026-04543-1","DOIUrl":"10.1186/s12890-026-04543-1","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated lung ultrasound (LUS) for distinguishing nonspecific interstitial pneumonia (NSIP) from usual interstitial pneumonia (UIP) and its association with clinical and functional parameters.</p><p><strong>Methods: </strong>Seventy-six patients with HRCT-diagnosed UIP (n = 42) or NSIP (n = 34) underwent LUS. We analyzed clinical characteristic and LUS parameters, including coalescent (c-LUSS), quantitative (q-LUSS), and pleural scores. Logistic and linear regressions identified LUS parameters associated with UIP/NSIP and pulmonary function tests. ROC analysis evaluated the diagnostic performance of sex combined with pleural line total score.</p><p><strong>Results: </strong>Patients with UIP had higher pleural line total, morphology, disruption, and fragmentation scores (all P < 0.05). Adjusted models identified several independent predictors distinguishing NSIP from UIP, notably the c-LUSS plus pleural line total score (OR: 1.06; 95% CI: 1.01-1.12), q-LUSS plus pleural line total score (OR: 1.07; 95% CI: 1.02-1.13), and pleural line total score (OR: 1.12; 95% CI: 1.03-1.22), alongside specific morphological subscores. The c-LUSS plus pleural line total score (OR: 1.12, 95% CI: 1.02-1.23), q-LUSS plus pleural line total score (OR: 1.1, 95% CI: 1.01-1.2), pleural line total score (OR: 1.14, 95% CI: 1-1.29), pleural thickness score (OR: 1.37, 95% CI: 1.02-1.85) remained independently associated with the severe FEV1. Meanwhile, the q-LUSS (β: -5.88; 95% CI: -11.33 to - 0.44) and B-line score of 3 or more (β: -7.01; 95% CI: -13.48 to - 0.54) were independently associated with 6MWD in UIP/NSIP patients. Whereas, these LUS indicators cannot reliably predict the severity of diffusion dysfunction indexed by DLCO % predicted (all P > 0.05). Combining sex and pleural line total score yielded an AUC of 0.782 (95% CI: 0.677-0.887, bootstrap C-index: 0.772).</p><p><strong>Conclusions: </strong>LUS, especially pleural assessment, may support differentiation between UIP and NSIP, but it cannot replace HRCT or multidisciplinary assessment. It exhibits relatively low performance in evaluating the severity of pulmonary diffusion dysfunction. Further external validation is still needed.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015618","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}