Daily Respiratory Research Analysis

BACKGROUND: Nirsevimab, a long-acting monoclonal antibody against respiratory syncytial virus (RSV), was recently introduced to prevent infant RSV-related hospitalizations. Although efficacy has been demonstrated in clinical trials, real-world data on targeted immunization strategies remain limited. We aimed to evaluate the effectiveness of nirsevimab in preventing RSV-associated hospitalizations in infants under 12 months, within a seasonal program prioritizing infants born from April onwards. METHODS: We conducted a prospective, multicenter, matched case-control study across seven Italian hospitals during the 2024-2025 RSV season. Infants hospitalized with PCR-confirmed RSV bronchiolitis were matched 1:2 by age and date of admission to controls hospitalized for non-respiratory causes. Data were collected via electronic medical records. Immunization effectiveness (IE) was estimated using conditional logistic regression adjusted for sex assigned at birth, gestational age, birth weight, and clinical risk factors. Two pre-specified stratified analyses and a sensitivity analysis using inverse probability of treatment weighting (IPTW) were performed. RESULTS: A total of 138 infants were included (46 cases, 92 controls). Adjusted IE was 89.5% (95% CI: 60.3-97.2%). Stratified analyses yielded similar results among infants born after April 1 (IE: 88.4%, 95% CI: 56.5-96.9%) and those without risk factors (IE: 88.1%, 95% CI: 45.7-97.4%). IPTW analysis confirmed protection (IE: 79.6%, 95% CI: 53.5-91.0%). CONCLUSIONS: This study provides real-world evidence supporting the effectiveness of nirsevimab in a targeted seasonal immunization framework. These findings may inform phased implementation strategies and RSV prophylaxis policies in varied healthcare settings.

OBJECTIVE: Acute cardiogenic pulmonary edema (ACPE) is a significant cause of emergency department (ED) visits due to dyspnea. Non-invasive ventilation (NIV) is currently the recommended first-line treatment for respiratory failure secondary to ACPE. The aim of this study is to compare the effectiveness of high-flow nasal cannula (HFNC) and NIV in improving respiratory rate (RR) and other clinical outcomes in adult patients presenting to the ED with ACPE. METHODS: This study was conducted as a prospective, randomized, single-center, superiority trial with a 1:1 parallel-group allocation. All consecutive adult patients (≥18 years) who presented to our emergency department between July 2023 and April 2024 were screened for eligibility. Those meeting the inclusion and exclusion criteria were enrolled and randomly assigned in a 1:1 ratio to receive either high-flow nasal cannula (HFNC) or non-invasive ventilation (NIV) therapy. All analyses were performed according to the intention-to-treat (ITT) principle, with per-protocol (PP) analyses also presented for comparison. RESULTS: During the study period, 1376 patients were screened, and 178 were randomized. Baseline characteristics, including initial respiratory rates-34 (IQR, 30-38) breaths/min in the HFNC group and 33.5 (IQR, 30-37) in the NIV group-were similar between groups. In both intention-to-treat and per-protocol analyses, the change in respiratory rate at 120 min was similar across groups. No significant differences were observed in respiratory rates or their changes at 30, 60, and 120 min. Likewise, changes in other vital signs, arterial blood gas parameters, and dyspnea scores during follow-up did not differ significantly between the groups. CONCLUSION: In this study, no difference was found between HFNC and NIV in reducing the symptoms and signs of respiratory failure with oxygen-ventilation support in patients with acute cardiogenic pulmonary edema. Considering that HFNC provides better patient tolerability and comfort, it may be considered a viable alternative to NIV in this specific patient population.

OBJECTIVES: To systematically review the effectiveness of different types of interfaces in the treatment of critically ill patients with respiratory failure requiring NIV. METHODS: Parallel randomized controlled trials (RCTs) were identified through a search conducted in the MEDLINE, CENTRAL, EMBASE, and LILACS databases. Review Manager 5 software was used for direct comparisons. Risk ratios (RR) with 95% confidence interval (CI) or credible interval (CrI) were used for dichotomous outcomes. Continuous outcomes were reported as mean differences (MD) with 95% CIs. MetaInsight software was used for conducting network meta-analysis (NMA) with Bayesian random-effects models. RESULTS: A systematic search was conducted on August 4, 2022, and last updated on November 6, 2024. Seven studies were included, involving 406 patients, and four different interfaces (helmet, oronasal, nasal, and full-face) were utilized. Helmet may reduce intubation rate, ICU and hospital length of stay, when compared to oronasal mask (RR 0.38 [95% CrI 0.2 to 0.75], RR -3.34 [95% CrI -6.94 to 0.49] and RR -2.4 [95% CrI -6.23 to 1.62]), with low certainty of the evidence. Furthermore, the evidence is very uncertain regarding the effects of the helmet on reducing serious adverse events, with very low certainty of the evidence. The evidence remains uncertain for the outcomes of in-hospital mortality, serious adverse events, mild and moderate adverse events, comfort, and tolerance. CONCLUSIONS: The helmet interface probably reduces the length of stay and intubation rates when used for non-invasive ventilation in critically ill patients with respiratory failure. However, the findings should be interpreted with caution as it generates from RCT with small sample sizes. IMPLICATIONS FOR CLINICAL PRACTICE: This network meta-analysis offers comparative evidence to guide clinical decision-making regarding interface selection during noninvasive ventilation, with the potential to enhance treatment effectiveness and patient outcomes.