Chest最新文献

{"title":"Changes in Inhaled Antibiotic Associated lung function outcomes in the CFTR-Modulator Era.","authors":"Marianne S Muhlebach, Jane She, John J LiPuma, Michael R Kosorok","doi":"10.1016/j.chest.2026.09.016","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.016","url":null,"abstract":"<p><strong>Background: </strong>Chronic inhaled antibiotics are recommended for people with cystic fibrosis (pwCF) chronically infected with Pseudomonas aeruginosa (Pa). Yet, chronic antibiotics may increase risk for other infections and benefits may have changed as outcomes of pwCF improved.</p><p><strong>Research question: </strong>Does the risk of infections associated with inhaled antibiotic prescriptions and the treatment benefit on lung function differ by Pa infection status and has the antibiotic-associated treatment effect changed since introduction of CFTR-modulators.</p><p><strong>Study design and methods: </strong>US CF-Foundation Patient Registry data were analysed for the years 2011-2019. Pa infection status was defined per Leeds criteria. Analyses included inverse probability treatment weighting. Survival modeling compared differences in incidence of Aspergillus and Gram-negatives between pwCF prescribed versus not prescribed antibiotics-within each Pa infection cohort. Differences in lung function associated with inhaled antibiotics were modeled using generalized estimating equations, with testing whether the mean effect of antibiotics differed across CFTR-modulator eras (ivacaftor, lumacaftor/ivacaftor, tezacaftor/ivacaftor).</p><p><strong>Results: </strong>From 2011 to 2019 the number of pwCF analysed increased from 12,000 to 16,041, with decreasing prevalence in chronic Pa, increasing age and better lung function. Risk of Aspergillus infections was higher in antibiotic prescribed vs. non-prescribed pwCF: HR 1.33 (CI_95% 1.26, 1.41) and was significantly higher in Pa negative compared to Pa chronic pwCF. Similarly, inhaled antibiotics were associated with increased risk of Stenotrophomonas maltophilia and Achromobacter: HR 1.21, (CI_95% 1.14, 1.29) and 1.26 (CI_95% 1.14, 1.39), respectively. Inhaled antibiotics were associated with higher lung function in chronic Pa but lower lung function in Pa negative pwCF. The antibiotic-associated treatment effect on lung function decreased over the three eras of CFTR-modulators.</p><p><strong>Interpretation: </strong>The risk of treatment emergent infections was highest in Pa negative pwCF who conversely did not have antibiotic-associated benefit on lung function. For pwCF with chronic Pa the antibiotic-associated benefit decreased as CFTR-modulator use increased.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015776","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 Role of Regret in Extracorporeal Membrane Oxygenation Candidacy Decision-Making.","authors":"Jonah Rubin, Alexander Jacobs, Annabel Siegal, Derek Soled, Jacqueline Kruser, Uzi Segal","doi":"10.1016/j.chest.2026.09.009","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.009","url":null,"abstract":"<p><strong>Background: </strong>Veno-venous extracorporeal membrane oxygenation (VV ECMO) candidacy decisions are made under substantial uncertainty and are inconsistent. With a team including economist decision-scientists, we applied Regret Theory to hypothesize that ECMO clinicians' perceived past and anticipated regret is an important influence on these decisions and contributes to inconsistency.</p><p><strong>Research question: </strong>Does regret influence ECMO candidacy decisions?</p><p><strong>Study design and methods: </strong>This is a secondary analysis of a qualitative semi-structured interview study with 24 ECMO clinicians from various international urban, rural, public, and private ECMO centers conducted between September and December 2024 to elicit clinicians' perceptions on ECMO candidacy decisions. In this study, a team of three investigators (two physicians; one economist) used directed qualitative content analysis, informed by Regret Theory, to examine whether and how clinicians' regret influences these decisions.</p><p><strong>Results: </strong>We identified three themes relating to the role of regret in ECMO candidacy decision-making: First, clinicians prefer utility-based reasoning, but it is often not possible. Second, regret of omission and commission both influence candidacy decisions. Finally, clinicians employ various strategies to minimize past and anticipated regret.</p><p><strong>Interpretation: </strong>We demonstrate that regret plays an influential role in how candidacy decisions are made, which may partly explain known inconsistencies in candidacy decisions within centers.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015782","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":"Time-Normalized Anti-Aspergillus IgG Kinetics for Monitoring Chronic Pulmonary Aspergillosis Progression.","authors":"Charles Gibert, Thomas Maitre, Cendrine Godet, Marie-Pierre Debray, Yaye Senghor, Christophe Hennequin, Jacques Cadranel, Jeanne Bigot, Juliette Guitard","doi":"10.1016/j.chest.2026.09.010","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.010","url":null,"abstract":"<p><strong>Background: </strong>Chronic pulmonary aspergillosis (CPA) requires prolonged follow-up combining clinical and radiological evaluation. Although anti-Aspergillus IgG is central for diagnosis, clinically meaningful changes during follow-up remain poorly defined.</p><p><strong>Research question: </strong>Do time-normalized anti-Aspergillus IgG kinetics reflect clinico-radiological CPA progression and provide candidate thresholds for intensified reassessment?</p><p><strong>Study design and methods: </strong>In this retrospective single-center study, patients with CPA with ≥2 follow-up visits spaced ≥3 months apart and paired anti-Aspergillus IgG measurements were included. Clinical and chest-CT evolution between visits was adjudicated by a multidisciplinary panel blinded to serology. IgG relative change was normalized to a 3-month interval. Stable/improved and worsening CPA visit-pairs were compared using unadjusted and patient-cluster-adjusted analyses. Receiver operating characteristic analysis and patient-level bootstrap resampling were used to explore candidate thresholds.</p><p><strong>Results: </strong>Twenty-two patients (79 sera; 57 visit-pairs) were analyzed. Fourteen visit-pairs (24.6%) were classified as worsening, of which three (5.3%) were not due to CPA, and 43 (75.4%) as stable/improved. Median time-normalized IgG relative change was higher in worsening than stable/improved CPA (1.28 [IQR: 1.02-1.71] vs 0.84 [IQR: 0.64-1.04], P<0.001). After accounting for within-patient clustering, the ratio of geometric means was 1.84 (95% CI: 0.97-3.48; P=0.059). The area under the curve was 0.84 (95% CI: 0.71-0.96). A candidate time-normalized IgG relative change threshold of 1.45/3 months provided 36.4% sensitivity and 97.7% specificity; while a 1.10/3 months threshold provided 72.7% sensitivity and 83.7% specificity. Patient-level bootstrap estimates supported internal consistency.</p><p><strong>Interpretation: </strong>Time-normalized anti-Aspergillus IgG kinetics were higher during worsening CPA, although cluster-adjusted uncertainty was substantial. A marked increase may serve as an exploratory rule-in signal prompting expedited imaging and microbiological reassessment, but values below the threshold should not exclude progression or delay evaluation. External validation is required before clinical implementation. These findings support the integration of quantitative serological kinetics into multimodal CPA monitoring strategies.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015810","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":"Central sleep apnea after stroke: prevalence, mechanisms, and clinical implications.","authors":"Anne-Kathrin Brill, Christian M Horvath, Sébastien Baillieul, Irina Filchenko, Marcel Arnold, Renaud Tamisier, Claudio L A Bassetti","doi":"10.1016/j.chest.2026.09.015","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.015","url":null,"abstract":"<p><strong>Topic importance: </strong>Central sleep apnea (CSA) and Cheyne-Stokes respiration (CSR) are common but underrecognized forms of sleep-disordered breathing after stroke. While obstructive sleep apnea dominates post-stroke research, CSA and CSR are neglected due to the fact that they rarely appear in isolation.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012079","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":"Impact of pre-ICU balanced crystalloids versus saline on mortality in sepsis: a propensity score-matched multicenter cohort study.","authors":"Tae Wan Kim, Yumi Kim, Moon Seong Baek, Gyungah Kim, Ryoung-Eun Ko, Gee Young Suh, Chae-Man Lim, Nakyung Jeon, Won-Young Kim","doi":"10.1016/j.chest.2026.09.008","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.008","url":null,"abstract":"<p><strong>Background: </strong>The optimal crystalloids for initial fluid resuscitation in sepsis remain uncertain. Most previous studies have focused on intensive care unit (ICU), leaving the pre-ICU admission impact of crystalloid type unclear.</p><p><strong>Research question: </strong>Is there an association between pre-ICU admission crystalloid type administration and clinical outcomes in patients with sepsis?</p><p><strong>Study design and methods: </strong>This nationwide multicenter retrospective cohort study analyzed adult patients with sepsis between September 2019 and December 2023. Patients receiving initial fluid resuscitation before ICU admission were categorized into balanced crystalloid or 0.9% sodium chloride (saline) groups. The primary outcome was 30-day mortality.</p><p><strong>Results: </strong>Among 3,688 patients (mean [standard deviation] age 71.9 [13.8] years; 58% male), 1,381 (37.4%) received balanced crystalloids and 2,307 (62.6%) received saline before ICU admission. After propensity score matching, 1,335 patients remained in each group. Balanced crystalloid use was associated with lower 30-day mortality, resulting in an adjusted odds ratio (aOR) of 0.69 (95% confidence interval [CI] 0.56-0.83). The finding was consistent after inverse probability of treatment weighting (aOR, 0.78; 95% CI 0.69-0.88). The association between balanced crystalloids and mortality was consistent across age, sex, disease severity, liberal fluid management (pre-ICU fluid volume >30 mL/kg), and pre-ICU vasopressor use. Notably, mortality risk was lower with balanced crystalloids in patients without chronic kidney disease, received fluids in the emergency department or ward (vs. operating room or other ICU), with baseline chloride ≤110 mmol/L, and baseline pH <7.35. Further, balanced crystalloid use was associated with reduced need for continuous renal replacement therapy during ICU stay, reduced renal replacement therapy at ICU discharge, and increased 28-day ventilator-free days.</p><p><strong>Interpretation: </strong>Pre-ICU administered balanced crystalloid use was associated with lower 30-day mortality in patients with sepsis than saline.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007697","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":"Delivering Bronchiectasis and NTM Care in Safety-Net Health Systems: A Practical Framework for Implementation.","authors":"Shelby MacRae, Colin Swenson, Robert C Flowers, Rocio M Hurtado, Diego J Maselli, Lisa Domaradzki, Jennifer Millero, Ashwin Basavaraj, B Shoshana Zha","doi":"10.1016/j.chest.2026.09.012","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.012","url":null,"abstract":"<p><strong>Topic: </strong>The prevalence of bronchiectasis and nontuberculous mycobacterial (NTM) pulmonary disease are rising and increasingly managed in United States community and safety-net health systems. However, patients cared for in these settings remain underrepresented in epidemiologic studies and clinical trials that inform clinical practice guidelines.</p><p><strong>Importance: </strong>Although existing recommendations provide important standards of care, they often assume reliable access to subspecialty evaluation, advanced diagnostics, and costly therapies. In under-resourced systems, structural constraints shape how and when patients obtain subspecialty evaluation and evidence-based therapies.</p><p><strong>Overview: </strong>Drawing on previous evidence and experience from centers within the Bronchiectasis and NTM Care Center Network, we propose a practical framework for adapting guideline-concordant care to under-resourced systems. This framework focuses on four domains: diagnostic pathways that support earlier recognition, co-management models that prioritize high-risk patients and leverage disease expertise, pragmatic approaches to evidence-based therapies aligned with available resources, and linguistic and culturally responsive education to support adherence and shared decision-making. Aligning evidence-based recommendations with structural realities is necessary to improve care delivery and reduce inequality in bronchiectasis and NTM care.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007714","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":"Thoracentesis with pleural fluid cytology versus thoracoscopy with pleural biopsy for the diagnosis of malignant pleural effusion: a cost-effectiveness study.","authors":"Greta J Bridwell, David Xiao, Horiana B Grosu, Udit Chaddha, Abhinav Agrawal, Yaron B Gesthalter, Caroline M Godfrey, Kaele Leonard, Ankush P Ratwani, Rafael Paez, Jennifer D Duke, Christina Pichiarello, Michael N Kammer, David Ost, Eric L Grogan, Robert J Lentz, Fabien Maldonado, Samira Shojaee","doi":"10.1016/j.chest.2026.08.051","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.051","url":null,"abstract":"<p><strong>Background: </strong>Thoracentesis with pleural fluid (PF) cytology has a sensitivity of ∼60% to diagnose malignant pleural effusion (MPE). Medical thoracoscopy with pleural biopsy has a higher diagnostic sensitivity. This study evaluates the cost-effectiveness of thoracentesis versus thoracoscopy for diagnosis of MPE in patients with prior or active malignancy.</p><p><strong>Research question: </strong>When is thoracentesis or thoracoscopy cost-effective for the diagnosis of malignant pleural effusion in patients with prior or active malignancy?</p><p><strong>Study design and methods: </strong>A cost-effectiveness model was developed comparing thoracentesis with PF-cytology to medical thoracoscopy with pleural biopsy for the diagnosis of MPE in two scenarios: 1) initial evaluation of unilateral pleural effusion in patients with prior or active malignancy, 2) evaluation of a recurrent effusion following a cytology-negative thoracentesis. The primary outcome was cost per complication avoided with willingness-to-pay threshold of $10,000. One-way deterministic sensitivity analyses were conducted on all parameters. Model assumptions were established by consensus among a multicenter panel of pleural disease experts.</p><p><strong>Results: </strong>In unilateral pleural effusion and prior or active malignancy, a thoracoscopy-first diagnostic strategy resulted in 0.0311 fewer complications and cost an additional $1,890 compared to a thoracentesis-first strategy. Thoracoscopy-first strategy was more cost-effective when PF-cytology sensitivity was ≤27%. In recurrent effusion following a cytology-negative thoracentesis in patients with prior or active malignancy, a thoracoscopy-next strategy resulted in 0.0278 fewer complications and cost an additional $19 compared to the thoracentesis-next strategy. Thoracoscopy-next strategy was more cost-effective unless the second-thoracentesis PF-cytology sensitivity was above 29%.</p><p><strong>Interpretation: </strong>In patients with prior or active malignancy, thoracentesis is a more cost-effective initial diagnostic strategy for malignant pleural effusion in cancers that have a PF-cytology diagnostic sensitivity of >27%. In recurrent effusion following a cytology-negative thoracentesis, thoracoscopy with pleural biopsy is more cost-effective than a second thoracentesis.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007812","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":"Non-Cystic Fibrosis Bronchiectasis in the United States: Prevalence Trends in a Large Electronic Health Record Population, 2015-2025.","authors":"Frederick Jung, Shelby MacRae","doi":"10.1016/j.chest.2026.09.014","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.014","url":null,"abstract":"<p><strong>Background: </strong>Despite growing clinical awareness of bronchiectasis, contemporary estimates of its burden in the general United States population are lacking.</p><p><strong>Research question: </strong>What are the trends in prevalence of non-cystic fibrosis bronchiectasis in a US primary care population from 2015-2025, and how does prevalence vary by demographic characteristics and subspecialist evaluation?</p><p><strong>Study design and methods: </strong>We conducted a retrospective, repeated cross-sectional population analysis using the Epic Cosmos electronic health record database encompassing over 307 million de-identified patients across the US. Adults aged ≥18 years with at least one visit to an internal medicine, family medicine, geriatrics, or gynecology provider between 2015 and 2025 formed the primary care (PC) population. Bronchiectasis (excluding cystic fibrosis) was identified by ICD-10 and CPT codes requiring a discharge diagnosis, two clinic visits with a billed diagnosis, or one visit with a billed diagnosis preceded by a chest CT. We calculated annual age-adjusted prevalence rates with 95% confidence intervals and performed multivariable regression.</p><p><strong>Results: </strong>In 2025, the PC population included over 58 million patients. There were 191,203 individuals who met the bronchiectasis case definition, yielding an age-adjusted prevalence of 270.3 (95% CI, 267.2-273.5) per 100,000 patients. Prevalence increased 133% from 2015 to 2025. Patients with case-defined bronchiectasis were older (average age 72.1 vs 58.1), more often female (66% vs 60%), more likely to identify as white (75.3% vs 63.8%), less likely to identify as Hispanic or Latino (5% vs 9%), and more likely to have Medicare coverage (61.4% vs 23.5%) than the PC population.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007723","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":"Mixed Mucus Plug-Emphysema Subtype and Acute Exacerbation in Chronic Obstructive Pulmonary Disease.","authors":"Yang Li, Yuxia Wang, Min Zhang, Guoxuan Wang, Jia Cui, Ziqing Zhang, Xiaoyan Wang, Xingxia Yang, Yanfei Guo","doi":"10.1016/j.chest.2026.09.006","DOIUrl":"https://doi.org/10.1016/j.chest.2026.09.006","url":null,"abstract":"<p><strong>Background: </strong>Conventional clinical assessments inadequately capture chronic obstructive pulmonary disease (COPD) heterogeneity. Quantitative computed tomography metrics may enable refined phenotyping and improved prognostic assessment.</p><p><strong>Research question: </strong>What is the prognostic value of quantitative computed tomography-derived mucus plugs and emphysema for acute exacerbations in COPD?</p><p><strong>Study design and methods: </strong>This prospective cohort study collected clinical data, chest computed tomography, and pulmonary function tests from patients with COPD. Patients were stratified by mucus plug score (cutoff: 4) and emphysema severity (%LAA-950 cutoff: 5%). Multivariate logistic regression analysis was performed to assess the association between subgroups and acute exacerbations. Stratified analysis was employed to evaluate both independent and combined effects.</p><p><strong>Results: </strong>A total of 215 patients were categorized into four subgroups: low mucus/low emphysema (n=61), low mucus/high emphysema (n=46), high mucus/low emphysema (n=62), and high mucus/high emphysema (n=46). Compared with the low mucus/low emphysema group, the risk of acute exacerbation increased progressively across the other three subgroups, with adjusted ORs of 2.885 (95%CI:1.060-8.166, P=0.041), 3.134 (95%CI:1.212-8.540, P=0.021), and 3.297 (95%CI:1.096-10.298, P=0.036). Additionally, each 1-point increase in the mucus plug score was associated with a 1.1-fold higher risk of acute exacerbation (OR 1.111, 95%CI: 1.005-1.232, P=0.041). The association between higher mucus plugs (≥4 vs. <4) and acute exacerbations was statistically significant only in the low emphysema subgroup (OR 3.318, 95%CI: 1.114-10.731, P=0.036).</p><p><strong>Interpretation: </strong>Quantitative computed tomography-defined mucus plugs and emphysema jointly identify clinically meaningful COPD subgroups and predict exacerbations, supporting their use for personalized risk stratification and targeted prevention.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007748","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":"Multicomponent Pulmonary Rehabilitation for Prolonged Mechanical Ventilation in Patients Aged 80 Years or Older: A Randomized Controlled Trial.","authors":"Tingting Liu, Ting Kou, Ge Wei, Hongyun Zhang, Gaoqiang Li, Huiru Hou, Bing Liu, Jing Zhao","doi":"10.1016/j.chest.2026.08.050","DOIUrl":"https://doi.org/10.1016/j.chest.2026.08.050","url":null,"abstract":"<p><strong>Background: </strong>Older patients receiving prolonged mechanical ventilation have a low likelihood of successful ventilator liberation and remain at risk for infectious complications and death.</p><p><strong>Research question: </strong>In patients aged ≥80 years receiving prolonged mechanical ventilation, does a multicomponent pulmonary rehabilitation program increase successful weaning?</p><p><strong>Study design and methods: </strong>This single-center, assessor-blinded randomized controlled trial was conducted at Chinese PLA General Hospital. Patients aged ≥80 years receiving prolonged mechanical ventilation were randomized to multicomponent pulmonary rehabilitation or standard rehabilitation. The primary outcome was successful weaning. Secondary outcomes were oxygen saturation off mechanical ventilation, diaphragm thickening fraction, cough ability, muscle strength, and the incidence of ventilator-associated pneumonia (VAP) assessed at 30, 60, and 90 days. Deep vein thrombosis (DVT) was assessed at day 90 or when participation ended.</p><p><strong>Results: </strong>The intention-to-treat analysis included 75 patients in each group. Among patients who received the multicomponent pulmonary rehabilitation program, 45.3% achieved successful weaning, compared with 12.0% among patients receiving standard rehabilitation (adjusted HR = 5.11; 95% CI, 2.46-11.23; P < 0.001). There was no significant difference in the incidence of DVT between the two groups. The intervention group had higher odds of meeting the prespecified improvement criteria for oxygen saturation, diaphragm thickening fraction, cough strength, and muscle strength at 30, 60, and 90 days, while VAP incidence was lower at days 60 and 90. The all-cause mortality rate at 90 days was 2.7% (2/75) in the trial group and 4.0% (3/75) in the control group (P = 1.000). The per-protocol analysis yielded similar results. The Fine-Gray competing-risk analysis yielded an sHR of 4.45 (95% CI, 2.11-9.36; P < 0.001).</p><p><strong>Interpretation: </strong>In patients aged ≥80 years receiving prolonged mechanical ventilation, the multicomponent pulmonary rehabilitation program improved physiological recovery and significantly increased successful weaning.</p><p><strong>Clinical trial registration: </strong>Chinese Clinical Trial Registry; ChiCTR2100050342; registered on August 26, 2021; URL: https://www.chictr.org.cn/.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.8,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007720","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}