Daily Respiratory Research Analysis
A phase II randomized trial in pediatric ARDS shows that a computerized decision support–guided lung-and-diaphragm protective strategy shortens ventilator weaning. A population-scale cohort from Australia finds remote patient monitoring for acute COVID-19 is associated with lower 28-day mortality and shorter hospital stays. A novel nanoparticle immunoassay applied to standard surgical facemasks enables noninvasive, dose-dependent detection of exhaled MPO, a biomarker of neutrophilic airway infla
Summary
A phase II randomized trial in pediatric ARDS shows that a computerized decision support–guided lung-and-diaphragm protective strategy shortens ventilator weaning. A population-scale cohort from Australia finds remote patient monitoring for acute COVID-19 is associated with lower 28-day mortality and shorter hospital stays. A novel nanoparticle immunoassay applied to standard surgical facemasks enables noninvasive, dose-dependent detection of exhaled MPO, a biomarker of neutrophilic airway inflammation in COPD.
Research Themes
- Lung- and diaphragm-protective ventilation guided by decision support
- Remote patient monitoring and real-world outcomes in acute COVID-19
- Noninvasive biomarker capture from facemasks for airway inflammation
Selected Articles
1. Randomized Trial of Lung and Diaphragm Protective Ventilation in Children.
In a single-center phase II RCT of pediatric ARDS, a CDS- and esophageal manometry–guided lung-and-diaphragm protective ventilation strategy shortened the length of ventilator weaning compared with usual care and reduced peak inspiratory pressure when patients were triggering breaths. Daily SBTs were performed in both arms. Findings support proceeding to multicenter phase III trials.
Impact: This is a rigorously designed randomized trial demonstrating clinically meaningful weaning benefits from a mechanistically informed ventilation strategy in children—a high-need population with limited trial data.
Clinical Implications: Adopting CDS-guided lung-and-diaphragm protective ventilation with esophageal manometry may reduce weaning time and ventilator-induced diaphragm dysfunction risk in pediatric ARDS; implementation should await validation in multicenter phase III trials.
Key Findings
- CDS- and manometry-guided ventilation reduced peak inspiratory pressure during patient-triggered breaths (adjusted mean difference −3 cmH2O).
- Primary outcome: the strategy significantly shortened the length of ventilator weaning versus usual care.
- Daily standardized spontaneous breathing trials were feasible in both arms, supporting protocolized weaning.
Methodological Strengths
- Randomized controlled design with protocolized spontaneous breathing trials
- Mechanistically guided intervention (CDS plus esophageal manometry) aligned with lung and diaphragm protection
Limitations
- Single-center phase II trial limits generalizability
- Not powered for mortality or long-term functional outcomes
Future Directions: Conduct multicenter phase III RCTs to confirm efficacy, evaluate sedation exposure, diaphragm function, and longer-term outcomes, and test scalability of CDS-assisted strategies.
BACKGROUND: Mechanical ventilation strategies that balance lung and diaphragm protection have not been extensively tested in clinical trials. METHODS: We conducted a single-center, phase II randomized controlled trial in children with acute respiratory distress syndrome with two time points of random assignment: the acute and weaning phases of ventilation. Patients in the intervention group were managed with a computerized decision support (CDS) tool, named REDvent, and esophageal manometry to deliver lung and diaphragm protective ventilation. The control group received usual care. A daily standardized spontaneous breathing trial (SBT) was performed in both groups. The primary outcome was the length of weaning. RESULTS: From October 2017 through March 2024, 248 children were randomly assigned to the acute phase. When participants were triggering the ventilator, the adjusted mean difference (REDvent-acute - usual care-acute) for peak inspiratory pressure was -3 cmH CONCLUSIONS: A lung and diaphragm protective ventilation strategy using a CDS tool during the acute phase of ventilation resulted in a shorter length of weaning than usual care. Phase III trials in mechanically ventilated patients are warranted. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT03266016.).
2. Remote patient monitoring for managing acute COVID-19, and mortality and hospital use in Sydney, New South Wales, 2021-22: a retrospective observational cohort study.
Among 276,236 SARS-CoV-2–positive adults in Sydney, participation in remote patient monitoring was associated with substantially lower 28-day mortality (aOR ~0.2), a higher likelihood of hospital admission within 14 days, but a 2–3.5 day shorter hospital stay. Propensity score matching and IPTW analyses yielded consistent results, suggesting earlier detection and management of deterioration.
Impact: This is one of the largest real-world evaluations of RPM during the Omicron era showing mortality benefit and shorter length of stay, informing health system decisions on scaling RPM beyond COVID-19.
Clinical Implications: Health systems may prioritize RPM for high-risk acute COVID-19 patients to reduce mortality and optimize bed utilization; careful triage is needed as RPM can increase admissions while shortening stays.
Key Findings
- 28-day all-cause mortality was markedly lower with RPM (PSM aOR 0.19; IPTW aOR 0.21).
- RPM increased 14-day hospital admissions but shortened mean length of stay by ~2.0–3.5 days across analyses.
- ICU admission and ED presentation at 14 days were similar between RPM and usual care.
Methodological Strengths
- Very large cohort with deterministically linked administrative and clinical datasets
- Robust causal inference methods (propensity score matching and IPTW) with consistent findings
Limitations
- Observational design with potential residual confounding and selection bias into RPM
- RPM exposure limited to one health district; generalizability may vary by model and resources
Future Directions: Prospective pragmatic trials and implementation studies to refine triage, cost-effectiveness, and equity; extend RPM frameworks to other acute infections and chronic respiratory diseases.
OBJECTIVES: To evaluate the influence of remote patient monitoring (RPM) for managing people with acute coronavirus disease 2019 (COVID-19) on 28-day mortality and hospital use in Australia. STUDY DESIGN: Retrospective observational cohort study; analysis of deterministically linked NSW Notifiable Conditions Information Management System and hospital, emergency department, and non-admitted patient data. SETTING, PARTICIPANTS: South Eastern Sydney Local Health District catchment area residents aged 15 years or older for whom positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test results (polymerase chain reaction or rapid antigen testing) during 26 November 2021 - 30 June 2022 were recorded. MAIN OUTCOME MEASURES: Primary outcome: All-cause mortality within 28 days of positive SARS-CoV-2 test result. SECONDARY OUTCOMES: Hospital length of stay, and numbers of emergency department presentations, hospital admissions, and intensive care unit admissions within 14 days of positive test results. All analyses were undertaken for the unadjusted data (original cohort analysis) and after propensity score matching and inverse probability treatment weighting. RESULTS: Of 276 236 people aged 15 years or older with positive SARS-CoV-2 test results and complete demographic information, 4399 (1.6%) participated in RPM. Twenty-eight-day mortality was lower for the RPM group than the usual care group (propensity score-matched: adjusted odds ratio [aOR], 0.19; 95% confidence interval [CI], 0.08-0.43; inverse probability treatment-weighted: aOR, 0.21; 95% CI, 0.10-0.46). The 14-day likelihood of intensive care unit admission and emergency department presentation was similar for both groups; the likelihood of hospital admission was higher for the RPM group (propensity score-matched: aOR, 1.42; 95% CI, 1.12-1.78; inverse probability treatment-weighted: aOR, 1.51; 95% CI, 1.28-1.78), but the mean hospital length of stay was shorter (adjusted mean difference, original cohort: -2.01 [95% CI, -2.81 to -1.21] days; propensity score-matched: -3.54 [95% CI, -6.39 to -0.69] days; inverse probability treatment-weighted: -3.26 [95% CI, -6.01 to -0.50] days). CONCLUSION: RPM was associated with greater 14-day likelihood of hospital admission, but also with shorter mean length of stay and lower 28-day mortality, which may indicate that clinical deterioration was detected and treated earlier than with usual care. The benefit of RPM for managing other acute health conditions in the community, particularly infectious diseases, should be examined.
3. A Nanoparticle-Based Immunoassay on Facemasks for Evaluating Neutrophilic Airway Inflammation in COPD Patients.
The authors developed a nanoparticle immunoassay applied via decals onto surgical facemasks worn for 30 minutes, enabling dose-dependent quantification of exhaled MPO—a biomarker of neutrophilic airway inflammation—without sputum. The approach showed specific MPO capture from masks and analytical performance suitable for clinical monitoring, offering a noninvasive, low-burden assessment during routine mask use.
Impact: This method transforms widely used facemasks into sampling devices for airway inflammation, enabling objective monitoring where sputum is unavailable and potentially guiding COPD exacerbation management.
Clinical Implications: Noninvasive MPO monitoring via masks could complement or replace subjective sputum assessment, facilitating earlier detection of neutrophilic exacerbations and personalized anti-inflammatory strategies in COPD.
Key Findings
- Antibody-coated nanoparticles transferred by decals specifically bound MPO captured in surgical facemasks worn for 30 minutes.
- The assay quantified MPO in a dose-dependent manner over a clinically relevant dynamic range.
- The approach avoids sputum collection, addressing bias and feasibility limitations of current exacerbation assessments.
Methodological Strengths
- Innovative translation of ubiquitous facemasks into bio-sampling platforms
- Demonstrated specific, dose-dependent immunoassay performance suitable for point-of-care use
Limitations
- Clinical validation cohort size and longitudinal predictive performance were not detailed
- Assay standardization and external validation across mask types and patient populations are needed
Future Directions: Prospective studies to correlate mask-MPO with clinical exacerbations, integrate multiplex inflammatory markers, and assess home-based monitoring impact on COPD outcomes.
Patients with chronic obstructive pulmonary disease (COPD) often experience acute exacerbations characterized by elevated neutrophilic inflammation in the lungs. Currently, this condition is diagnosed through visual inspection of sputum color and volume, a method prone to personal bias and unsuitable for patients who are unable to expectorate spontaneously. In this manuscript, we present a novel approach for measuring and monitoring exhaled myeloperoxidase (MPO), a biomarker of neutrophilic airway inflammation, without the need for sputum analysis. The method involves analyzing an unmodified surgical facemask worn by the patient for 30 min using biosensing decals that transfer antibody-coated nanoparticles. These colloids specifically interact with MPO trapped by the facemask in a dose-dependent manner, enabling the quantification of MPO levels, with a dynamic range up to 3 · 10