Daily Respiratory Research Analysis
Three studies reshape respiratory care across prevention, management, and surveillance: a large EHR-based analysis refined incidence estimates of Long COVID in adults and children; a decade-long, multicenter surveillance quantified RSV hospitalization burden in older adults and demonstrated underestimation by narrow case definitions; and a systematic review/meta-analysis found noninvasive oxygenation/ventilation strategies associated with lower ICU mortality versus invasive ventilation in viral
Summary
Three studies reshape respiratory care across prevention, management, and surveillance: a large EHR-based analysis refined incidence estimates of Long COVID in adults and children; a decade-long, multicenter surveillance quantified RSV hospitalization burden in older adults and demonstrated underestimation by narrow case definitions; and a systematic review/meta-analysis found noninvasive oxygenation/ventilation strategies associated with lower ICU mortality versus invasive ventilation in viral acute respiratory failure.
Research Themes
- Long COVID incidence and EHR-based phenotyping
- RSV hospitalization burden and case definition effects in older adults
- Noninvasive oxygenation/ventilation strategies for viral acute respiratory failure
Selected Articles
1. Long COVID Incidence Proportion in Adults and Children Between 2020 and 2024: An Electronic Health Record-Based Study From the RECOVER Initiative.
Across three national EHR networks, 4% of children and 10–26% of adults met computable phenotype definitions for Long COVID 30–180 days post-infection, with excess incidence of 1.5% in children and 5–6% in adults versus controls. Temporal peaks aligned with variant waves. A harmonized adult definition improved comparability across networks.
Impact: Provides robust, multi-network estimates of Long COVID incidence with controls and temporal context, informing surveillance, prevention, and resource allocation.
Clinical Implications: Quantifies the continuing burden of Long COVID in adults and children, supports targeted follow-up 30–180 days post-infection, and underscores the need for standardizable phenotyping across health systems.
Key Findings
- Long COVID incidence was 4% in children and 10–26% in adults depending on computable phenotype and network.
- Excess incidence versus controls was 1.5% (children) and 5–6% (adults), representing a conservative lower bound.
- Temporal peaks in incidence were consistent with introduction of new SARS-CoV-2 variants across networks.
- A harmonized adult definition improved comparability of estimates across networks.
Methodological Strengths
- Multi-network EHR-based cohort with both contemporary COVID-negative and historical controls
- Use of computable phenotypes and a harmonized adult definition to test robustness
Limitations
- Potential misclassification and ascertainment bias inherent to EHR-based phenotyping
- Heterogeneity across networks in data capture and phenotype algorithms; residual confounding
Future Directions: Prospective validation of computable phenotypes, integration of patient-reported outcomes and biomarkers, and evaluation of prevention strategies (e.g., vaccination, glycemic control) on Long COVID incidence.
2. Ten-Year Surveillance of Respiratory Syncytial Virus Hospitalizations in Adults: Incidence Rates and Case Definition Implications.
In a 10-season, multicenter, actively monitored cohort, RSV hospitalizations in adults ≥60 years ranged from 21–402 per 100,000 person-years, highest in those ≥80 years. Using an ILI-only case definition underestimated RSV hospitalizations by 13–40% compared with an ILI/SARI definition, indicating the need for broader surveillance criteria.
Impact: Quantifies RSV burden in older adults over a decade and demonstrates how narrow case definitions undercount events, directly informing vaccine policy, surveillance, and resource planning.
Clinical Implications: Adopt broader ILI/SARI-based definitions to better capture RSV hospitalizations and prioritize immunization and prevention strategies for adults ≥80 years.
Key Findings
- Across 10 seasons, RSV hospitalization incidence in adults ≥60 years varied from 21–402 per 100,000 person-years and was highest among those ≥80 years.
- ILI-only case definitions underestimated RSV hospitalizations by 13–40% versus ILI/SARI.
- Approximately 1 in 1000 adults ≥60 years are hospitalized for RSV annually on average.
Methodological Strengths
- Prospective, multicenter active surveillance over 10 seasons with population coverage up to 46%
- Stratified incidence estimates and comparison of alternative case definitions
Limitations
- Regional study may limit generalizability; hospital participation varied by season
- Potential underdiagnosis due to testing practices despite active monitoring
Future Directions: Evaluate vaccine effectiveness in real-world implementation, refine surveillance algorithms, and assess cost-effectiveness of broad case definitions.
3. Noninvasive oxygenation and ventilation strategies for viral acute respiratory failure: a comprehensive systematic review and meta-analysis.
Across 47 studies, HFNC (RR 0.54), NIV (RR 0.70), and CPAP (RR 0.80) were associated with lower ICU mortality compared with IMV in viral ARF, with meta-regression reducing heterogeneity to 0% for several comparisons. ICU length of stay was modestly reduced with NIV and HFNC. Evidence certainty ranged from very low to medium, warranting cautious interpretation.
Impact: Synthesizes comparative effectiveness evidence supporting noninvasive strategies that can reduce mortality and ICU resource burden during viral respiratory pandemics.
Clinical Implications: Incorporate HFNC/NIV/CPAP pathways early in viral ARF care, with protocols and monitoring to mitigate failure risk; plan surge capacity emphasizing noninvasive modalities.
Key Findings
- HFNC (RR 0.54), NIV (RR 0.70), and CPAP (RR 0.80) were associated with lower ICU mortality versus IMV; heterogeneity was minimized by meta-regression.
- ICU length of stay was modestly reduced with NIV (−0.38 days) and HFNC (−0.29 days).
- Evidence certainty by GRADE ranged from very low to medium, with limited data on nosocomial infection and barotrauma.
Methodological Strengths
- Cochrane- and PRISMA-compliant methods with random-effects meta-analysis and meta-regression
- Comparative assessment across multiple noninvasive modalities versus IMV
Limitations
- Overall certainty low to medium; likely inclusion of nonrandomized studies and variable confounding control
- Insufficient data to meta-analyze nosocomial infection and barotrauma
Future Directions: Conduct high-quality RCTs stratified by viral etiology and ARDS severity; evaluate failure predictors and standardized escalation criteria for noninvasive strategies.