Daily Ards Research Analysis

UNLABELLED: The aim of the present systematic review was to determine whether non-invasive intermittent positive pressure ventilation (NIPPV), as initial respiratory support for preterm infants with respiratory distress syndrome (RDS), reduces the incidence of invasive ventilation (IV) and bronchopulmonary dysplasia (BPD) more effectively than nasal continuous positive airway pressure (NCPAP). We systematically searched Medline, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) for records published between 1980 and February 2022. RCTs comparing early NIPPV with NCPAP as initial respiratory support in preterm infants with RDS were included. Two reviewers independently extracted data. Pooled relative risks (RRs) with 95% confidence intervals (CI) were calculated using random-effects meta-analysis. Subgroup analyses were performed for infants receiving surfactant and stratified by gestational age (GA) or birth weight (BW). The primary outcomes were the incidence of IV and BPD. A total of 14 randomized clinical trials (RCTs) involving 1755 infants were included. Compared with NCPAP, early NIPPV significantly reduced the incidence of IV (risk ratio [RR], 0.53; 95% CI, 0.43-0.64; P < .001) and the incidence of BPD (RR, 0.48; 95% CI, 0.29-0.79; P = .004). The reduction in the incidence of IV remained statistically significant across multiple subgroups: GA > 30 weeks (RR, 0.41; 95% CI, 0.27-0.63; P < .001) and GA ≤ 30 weeks (RR, 0.31; 95% CI, 0.20-0.48; P < .001); infants treated with surfactant (RR, 0.60; 95% CI, 0.43-0.83; P = .002); BW ≤ 1500 g (RR, 0.54; 95% CI, 0.38-0.77; P < .001) and BW > 1500 g (RR, 0.53; 95% CI, 0.36-0.77; P = .001). However, the reduction in the incidence of BPD was significant only in subgroups stratified by GA: GA > 30 weeks (RR, 0.40; 95% CI, 0.18-0.90; P = .03) and GA ≤ 30 weeks (RR, 0.33; 95% CI, 0.14-0.75; P = .008). CONCLUSION: Early NIPPV appears superior to NCPAP for reducing the incidence of IV and BPD in preterm infants with RDS. Nevertheless, higher-quality evidence is needed for definitive recommendations. WHAT IS KNOWN: • Nasal intermittent positive pressure ventilation (NIPPV) delivers cyclical peak pressure support and may outperform nasal continuous positive airway pressure (NCPAP). While some randomized controlled trials (RCTs) show NIPPV reduces invasive ventilation rates compared to NCPAP, its effect on bronchopulmonary dysplasia (BPD) incidence remains inconclusive. WHAT IS NEW: • NIPPV appears superior to NCPAP in reducing the incidence of IV and BPD in preterm infants with respiratory distress syndrome (RDS) as initial noninvasive respiratory support.

Central airway stenosis following congenital heart malformation surgery is a rare but significant cause of postoperative weaning failure. In selected cases, bronchoscopic interventions are effective treatment options for managing these kind of airway obstructions and achieving successful weaning.The data of six pediatric patients who were unable to be weaned from mechanical ventilation due to central airway obstruction following congenital heart malformation surgery were retrospectively analyzed. Rigid and flexible bronchoscopies were performed under general anesthesia for six patients.Six patients (4 males and 2 females; age range: 4 months to 6 years) with an airway obstruction after surgery due to congenital heart malformations included the study. Three patients had an obstruction of the left main bronchus, two of the right main bronchus, and one of bilateral main bronchus. Balloon dilatation was applied to one patient, mechanical dilatation was applied to three patients, and airway stent was applied to two patients. Two of six patients died from nonprocedural causes (acute respiratory distress syndrome due to pneumonia and cardiac arrest due to severe heart failure) and four patients were weaned successfully from mechanical ventilation and they were still alive during the follow-up period. No procedural-related mortality was seen in the study population. In one patient, stent placement could not be performed due to desaturation and hemodynamic instability during the procedure, and in another patient, granulation tissue developed due to a covered metallic stent, and the metallic stent was removed and replaced with a biodegradable stent.In selected cases, bronchoscopic interventions offer efficient approach to managing airway obstructions due to congenital heart malformation surgery.

BACKGROUND/AIM: Systemic lupus erythematosus (SLE) and Sjögren's syndrome (SS) are chronic autoimmune diseases that often coexist. They share features such as systemic inflammation and multi-organ involvement and typically require long-term immunosuppressive treatment. However, long-term use of immunosuppressants can cause serious side effects, highlighting the need for adjunct therapies. Molecular hydrogen (H CASE REPORT: We present the case of a 69-year-old female diagnosed with Sjögren's syndrome, SLE, and ILD. The patient exhibited chronic symptoms, including xerostomia, xerophthalmia, and respiratory distress, for which she had been receiving corticosteroids and immunomodulatory therapy. Given the persistent disease burden and concerns regarding long-term immunosuppressive therapy, molecular hydrogen therapy was introduced as an adjunctive treatment. Over several months, the patient experienced notable clinical improvements, including resolution of xerostomia, insomnia, dyspnea, chest pain, and dizziness. These symptomatic improvements correlated with favorable immunological shifts in T and B cell subsets, enhanced pulmonary imaging findings, and a reduction in inflammatory markers. Additionally, the patient reported a significant decrease in fatigue, allowing corticosteroid tapering and less reliance on nighttime oxygen. Ongoing hydrogen therapy with high-dose vitamin C maintained disease stability and improved quality of life. CONCLUSION: This case highlights the potential of molecular hydrogen (H