Daily Respiratory Research Analysis
A UK multicentre RCT found no clinical or economic benefit of extracorporeal CO2 removal for acute hypoxaemic respiratory failure, supporting non-use outside trials. An international pediatric bronchiectasis registry revealed substantial regional variation in causes, bacteriology, and care quality, identifying actionable gaps. A European analysis estimated substantial RSV hospitalisation rates in older adults, informing vaccination strategies and underscoring under-ascertainment in routine data.
Summary
A UK multicentre RCT found no clinical or economic benefit of extracorporeal CO2 removal for acute hypoxaemic respiratory failure, supporting non-use outside trials. An international pediatric bronchiectasis registry revealed substantial regional variation in causes, bacteriology, and care quality, identifying actionable gaps. A European analysis estimated substantial RSV hospitalisation rates in older adults, informing vaccination strategies and underscoring under-ascertainment in routine data.
Research Themes
- Critical care ventilation and extracorporeal support
- Pediatric bronchiectasis epidemiology and care quality
- RSV disease burden in older adults and vaccination policy
Selected Articles
1. Extracorporeal carbon dioxide removal for the treatment of acute hypoxaemic respiratory failure: the REST RCT.
In a 51-ICU pragmatic RCT (n=412), ECCO2R-facilitated lower tidal volume ventilation did not reduce 90-day mortality versus standard care (41.5% vs 39.5%; RR 1.05). No short- or long-term benefits were found; costs were higher and complications potentially significant, leading authors to advise against ECCO2R outside future trials.
Impact: This high-quality multicentre RCT provides definitive negative evidence on ECCO2R in hypoxaemic respiratory failure, guiding de-implementation and resource allocation.
Clinical Implications: Do not use ECCO2R to facilitate ultra-low tidal volumes for acute hypoxaemic respiratory failure outside clinical trials; standard lung-protective ventilation remains preferred.
Key Findings
- 90-day mortality: 41.5% (ECCO2R) vs 39.5% (standard); RR 1.05 (95% CI 0.83–1.33).
- No improvement in ventilator-free days, long-term outcomes, or quality of life.
- Higher costs and potentially significant complications with ECCO2R; trial stopped early for futility.
Methodological Strengths
- Multicentre randomized, allocation-concealed, pragmatic design across 51 ICUs.
- Comprehensive outcomes including costs, long-term morbidity, and quality of life.
Limitations
- Trial stopped early, potentially underpowered to detect modest effects.
- Open-label design; only 6% of screened patients enrolled; heterogeneity in usual care.
Future Directions: Investigate whether specific subgroups or higher 'dose' ECCO2R exposure benefit, using standardized core outcomes and early HRQoL measurement.
2. First results from the international paediatric bronchiectasis registry (Child-BEAR-Net Registry) describing multicountry variations in childhood bronchiectasis and its management: a multicentre, cross-sectional study.
In 408 children across eight countries, post-infectious causes (31%) and immunodeficiencies (19%) predominated, with 38% having ≥3 exacerbations and 49% hospitalized in the prior year. There were striking regional differences in lower-airway bacteriology, treatments (eg, azithromycin, inhaled steroids), lung function, and radiographic severity, and only 47% saw a paediatric physiotherapist.
Impact: First international pediatric bronchiectasis registry quantifies global heterogeneity and care gaps, directly informing guideline implementation and quality improvement.
Clinical Implications: Standardize diagnostic panels, prioritize access to pediatric physiotherapy, and tailor antimicrobial/anti-inflammatory strategies to regional bacteriology and comorbid profiles.
Key Findings
- Across 408 children, 31% post-infectious and 19% immunodeficiency etiologies; 38% had ≥3 exacerbations and 49% were hospitalized in the prior year.
- Marked regional differences in airway pathogens (e.g., H. influenzae 70% in Australia vs 16% in Albania–Türkiye–Ukraine; P. aeruginosa 24% in South Africa).
- Care quality gaps: only 47% saw a pediatric physiotherapist; radiographic cystic bronchiectasis 45% in South Africa vs 2% in Australia.
Methodological Strengths
- Multicountry, multicentre registry with standardized data elements.
- Direct comparison across predefined geographic regions with key quality-of-care indicators.
Limitations
- Cross-sectional design limits causal inference; potential selection bias to tertiary centers.
- Incomplete lung function data in some regions; unmeasured confounders.
Future Directions: Prospective longitudinal follow-up to link care processes with outcomes; implement and evaluate physiotherapy access and macrolide stewardship interventions across regions.
3. Estimating the respiratory syncytial virus-associated hospitalisation burden in older adults in European countries: a systematic analysis.
Using a systematic review, surveillance, and modelling, adjusted RSV hospitalisation rates in ≥60-year-olds were 2.2–6.4× higher than unadjusted. Direct estimates ranged from 193/100,000 (Netherlands/Finland) to 414/100,000 (Denmark), with ensemble predictions of 223–317/100,000 across 23 more countries; in-hospital CFR ranged 6.7–10.1%.
Impact: Timely, policy-relevant burden estimates for older adults across Europe accounting for under-ascertainment, directly informing RSV vaccination and resource planning.
Clinical Implications: Health systems should anticipate substantial RSV admissions among older adults and consider vaccination strategies and surveillance improvements that correct under-ascertainment.
Key Findings
- Adjusted RSV hospitalisation rates in ≥60-year-olds were 2.2–6.4 times higher than unadjusted estimates.
- Country estimates: Netherlands/Finland ~193 per 100,000 person-years; Denmark 414 per 100,000; ensemble predictions 223–317 per 100,000 in 23 additional countries.
- Estimated in-hospital case fatality ratio ranged from 6.73% (Spain) to 10.14% (Switzerland).
Methodological Strengths
- Combines systematic review, surveillance, and ensemble modelling with explicit adjustment for under-ascertainment.
- Provides both direct and modelled country-level estimates with uncertainty intervals.
Limitations
- Sparse direct data in many countries; modelling assumptions may not capture all heterogeneity.
- hCFR available for limited settings; diagnostic practices vary over time and place.
Future Directions: Expand standardized RSV testing and surveillance in older adults and validate model predictions prospectively to refine vaccine impact assessments.