Daily Respiratory Research Analysis
A multicenter randomized trial showed that a multimodal prehabilitation program significantly reduced postoperative pulmonary complications and hospital stay in high-risk lung resection patients. A double-blind phase 3 trial demonstrated that a heterologous booster with the chimeric mRNA vaccine RQ3013 reduced symptomatic COVID-19 compared with ZF2001 after prior inactivated vaccines. Real-world universal nirsevimab immunoprophylaxis was associated with striking reductions in RSV-related hospita
Summary
A multicenter randomized trial showed that a multimodal prehabilitation program significantly reduced postoperative pulmonary complications and hospital stay in high-risk lung resection patients. A double-blind phase 3 trial demonstrated that a heterologous booster with the chimeric mRNA vaccine RQ3013 reduced symptomatic COVID-19 compared with ZF2001 after prior inactivated vaccines. Real-world universal nirsevimab immunoprophylaxis was associated with striking reductions in RSV-related hospitalizations and PICU admissions in young infants.
Research Themes
- Perioperative respiratory complication prevention
- Heterologous mRNA booster efficacy against COVID-19
- Population-level impact of RSV immunoprophylaxis in infants
Selected Articles
1. Multimodal prehabilitation before lung resection surgery: a multicentre randomised controlled trial.
In a multicenter randomized trial of 122 high-risk patients undergoing lung resection, multimodal prehabilitation (including high-intensity respiratory muscle training) reduced postoperative pulmonary complications from 55% to 34% and shortened median hospital stay from 9 to 7 days. These findings support structured prehabilitation to improve perioperative respiratory outcomes.
Impact: This RCT provides high-level evidence that targeted prehabilitation can meaningfully reduce postoperative pulmonary complications—a leading cause of morbidity after thoracic surgery—and reduce length of stay.
Clinical Implications: Implement structured prehabilitation with respiratory muscle training for high-risk lung resection candidates to reduce pulmonary complications and hospital stay; integrate into perioperative pathways and preoperative clinics.
Key Findings
- Postoperative pulmonary complications were 34% with prehabilitation vs 55% with usual care (OR 2.29, 95% CI 1.10–4.77; P=0.029).
- Median hospital length of stay decreased from 9 (IQR 7–11) to 7 (IQR 6–9) days (P=0.038).
- The trial targeted patients at high risk for pulmonary complications and incorporated high-intensity respiratory muscle training within a multimodal program.
Methodological Strengths
- Multicenter randomized controlled design with clinically meaningful endpoints
- Prospective protocol targeting a well-defined high-risk surgical population
Limitations
- Sample size was modest (n=122) and follow-up limited to index hospitalization
- Details on blinding and adherence to training components are not described in the abstract
Future Directions: Evaluate long-term respiratory outcomes, cost-effectiveness, and scalability across diverse health systems; define optimal intensity/duration and identify responders.
BACKGROUND: Respiratory muscle training may improve ventilatory efficiency (V METHODS: We conducted a prospective multicentre, randomised controlled trial (NCT04826575) to examine the effect of prehabilitation in individuals undergoing lung resection. Participants were defined as high-risk for postoperative pulmonary complications if they achieved V RESULTS: A total of 122 patients (46% female; age range: 64-75 yr) completed the study. Postoperative pulmonary complications occurred in 20/58 (34%) of patients randomised to multimodal prehabilitation, compared with 35/64 (55%) patients receiving usual care (odds ratio 2.29 [95% confidence interval 1.10-4.77]; P=0.029). Hospital length of stay was shorter after multimodal rehabilitation compared with patients randomised to receive usual care (from 9 [7-11] days to 7 [6-9] days; P=0.038). After prehabilitation, mean (sd) V CONCLUSIONS: In high-risk patients undergoing elective lung resection surgery, multimodal prehabilitation, including high-intensity respiratory muscle training to target V
2. Efficacy, immunogenicity, and safety of heterologous boosting with a novel chimera Chinese mRNA (RQ3013) SARS-CoV-2 vaccine: A randomized, double-blind, active-controlled trial.
In adults primed with three doses of inactivated vaccines, a heterologous RQ3013 mRNA booster reduced symptomatic SARS-CoV-2 infection by 51.7% versus ZF2001 over four months, with incidence rates of 5.7 vs 11.8 per 100 person-years. The randomized, double-blind design supports robust comparative efficacy.
Impact: Provides high-quality randomized evidence for a heterologous mRNA booster strategy after inactivated vaccines, relevant to many global settings that used inactivated priming.
Clinical Implications: Supports use of an mRNA heterologous booster to enhance protection after inactivated vaccine schedules, informing booster policy in regions with similar priming histories.
Key Findings
- Symptomatic COVID-19 incidence: 11.8 vs 5.7 per 100 person-years for ZF2001 vs RQ3013 during 4 months.
- Relative efficacy of RQ3013 vs ZF2001: 51.7% (95% CI 30.9–66.2%).
- Randomized, double-blind, active-controlled phase 3 trial with >6,300 participants after three inactivated doses.
Methodological Strengths
- Randomized, double-blind, active-controlled phase 3 design
- Large sample size with event-based incidence rates and confidence intervals
Limitations
- Follow-up limited to 4 months and conducted during a specific outbreak context
- Comparator limited to ZF2001; efficacy against severe disease not detailed in the abstract
Future Directions: Assess durability, protection against severe outcomes, variant-specific effectiveness, and performance in broader demographics and comorbid populations.
A randomized, double-blind, controlled phase 3 trial was conducted during a COVID-19 outbreak after the initial, stringent zero-Covid policy was relaxed in three provinces. Eligible adults aged ≥18 years who had received three doses of inactivated COVID-19 vaccines 6 months earlier were randomly assigned in a 1:1 ratio to receive either one intramuscular injection of RQ3013 or ZF2001 vaccine. The primary end point was protection against PCR-confirmed symptomatic SARS-CoV-2 infection with onset at least 7 days after the booster. A total of 3,167 and 3,169 eligible participants received one dose of RQ3013 or ZF2001 vaccine, respectively. COVID-19 illness was confirmed in 91 participants in the ZF2001 group (11.8 per 100 person years; 95% confidence interval [CI]: 9.6-14.6) and in 45 participants in the RQ3013 group (5.7 per 100 person-years; 95% CI: 4.3-7.7) during a 4-month follow-up, resulting in a relative efficacy of 51.7% (95% CI, 30.9-66.2%) (
3. Universal administration of nirsevimab in infants: an analysis of hospitalisations and paediatric intensive care unit admissions for RSV-associated lower respiratory tract infections.
At a tertiary hospital, universal infant nirsevimab prophylaxis was associated with dramatic reductions in RSV-LRTI hospitalizations and PICU admissions, especially in infants <6 months, alongside older age at admission and shorter length of stay. These real-world data corroborate trial evidence for population-level impact.
Impact: Provides timely real-world effectiveness evidence for universal nirsevimab, informing RSV prevention policy and resource planning during early implementation.
Clinical Implications: Support universal nirsevimab in infancy to reduce RSV burden, particularly in infants <6 months; anticipate shifts in age distribution and reduced hospitalization duration.
Key Findings
- Among infants <6 months, hospitalizations decreased by 83.3% and PICU admissions by 73.3% versus prepandemic seasons.
- Compared with the postpandemic season, hospitalizations decreased by 90.8% and PICU admissions by 87.9%.
- Median age at hospitalization increased to 15.6 months and median length of stay decreased to 4 days during the nirsevimab period.
Methodological Strengths
- Multiple season comparisons (prepandemic and postpandemic) with a universal immunization period
- Consistent directional effects across hospitalizations, PICU admissions, age distribution, and length of stay
Limitations
- Single-center observational design susceptible to secular trends and unmeasured confounding
- No adjustment for potential changes in testing, circulation patterns, or healthcare-seeking behaviors
Future Directions: Confirm multi-center effectiveness with adjusted analyses, assess equity of uptake, and evaluate cost-effectiveness and impact on healthcare capacity.
The aim of this study was to assess the impact of universal nirsevimab administration on hospitalisations and paediatric intensive care unit (PICU) admissions due to lower respiratory tract infection associated with respiratory syncytial virus (RSV-LRTI). An observational study was conducted at a tertiary hospital in Spain to compare the frequency and characteristics of children under five years of age hospitalised for RSV-LRTI between October 2023 and March 2024 (nirsevimab period), with the data from two prepandemic COVID- 19 seasons (2018-2019 and 2019-2020) and one postpandemic season (2022-2023). A total of 311 patients were included in the study. During the nirsevimab period, a decrease in the number of children hospitalised for RSV-LRTI was observed, particularly for children under six months of age. Compared with the prepandemic period, there was an 83.3% decrease in hospitalisations and a 73.3% reduction in PICU admissions in this age group. Similarly, compared with the postpandemic period, there was a 90.8% reduction in hospitalisations and an 87.9% reduction in PICU admissions. Furthermore, the median age was greater (15.6 months; IQR 11.1-27.3) than it was in the prepandemic period (4 months; IQR 1.6-8.9) and postpandemic period (3.4 months; IQR 1.5-10.6) (p < 0.001). Moreover, the length of hospital stay during the nirsevimab period (4 days; IQR 3-6) was shorter than that observed during the prepandemic period (6 days; IQR 4-9) and the postpandemic period (5 days; IQR 3-8) (p = 0.003).Conclusions: Following the introduction of universal immunoprophylaxis with nirsevimab, notable reductions in hospitalisations and PICU admissions due to RSV-LRTI were observed among young infants. This resulted in a shift in the age profile and a shorter length of hospital stay. What Is Known • Nirsevimab is a novel humanised IgG1 monoclonal antibody with a prolonged half-life that has been demonstrated to reduce RSV-associated hospitalisations in controlled clinical trials; however, real-world data are still limited. What Is New: • The findings of the present study corroborate the effectiveness of nirsevimab. Following the implementation of universal immunoprophylaxis with nirsevimab, a notable reduction in hospitalisations and admissions to the paediatric intensive care unit for RSV-associated lower respiratory tract infections was observed, particularly among infants younger than 6 months, who have been the main target of this passive immunisation strategy. In addition, the patients admitted were older and the length of hospital stay was shorter.