Daily Respiratory Research Analysis
Analyzed 152 papers and selected 3 impactful papers.
Summary
Three impactful respiratory studies stood out: early changes in lung ultrasound scores reliably predicted failure of non-invasive respiratory support in hypoxemic adults; a universal infant nirsevimab program in Italy markedly reduced RSV-related emergency visits and hospitalizations; and prematurity—especially with bronchopulmonary dysplasia—was linked to more severe in-hospital outcomes among RSV-hospitalized children.
Research Themes
- Point-of-care ultrasound to guide respiratory support decisions
- Population-level RSV immunoprophylaxis effectiveness
- Risk stratification in premature infants with RSV hospitalization
Selected Articles
1. Early lung ultrasound score changes predict the failure of non-invasive respiratory supports in acute hypoxemic patients: a multicenter prospective observational study.
In 100 hypoxemic adults on HFNC/CPAP/NIV, 22% failed non-invasive support. Baseline clinical and ultrasound measures were similar across groups, but after 2 hours, only responders showed improved LUS aeration scores, and the change independently predicted treatment failure. Early LUS dynamics can thus stratify risk and inform escalation decisions.
Impact: Provides prospective, multicenter evidence that a simple bedside LUS reassessment at 2 hours predicts non-invasive support failure, enabling earlier, safer escalation.
Clinical Implications: Implement structured LUS reassessment 2 hours after initiating HFNC/CPAP/NIV to identify non-responders and prioritize timely escalation (e.g., intubation) while avoiding delayed rescue.
Key Findings
- Overall failure of non-invasive respiratory support was 22% among 100 hypoxemic adults.
- Baseline clinical and LUS measures did not discriminate failure; at 2 hours, failing patients had worse oxygenation (lower PaO2/FiO2).
- Improvement in LUS aeration score occurred only in responders and independently predicted treatment failure.
Methodological Strengths
- Prospective, multicenter international design with standardized early (2-hour) reassessment
- Objective bedside imaging metric (LUS aeration score) linked to clinically relevant outcomes
Limitations
- Modest sample size (n=100) with heterogeneous support modalities (HFNC, CPAP, NIV)
- Observational design without blinded LUS assessment or protocolized escalation
Future Directions: Validate LUS change thresholds and integrate LUS-guided escalation algorithms in pragmatic RCTs to assess patient-centered outcomes (mortality, ventilation-free days).
BACKGROUND: To determine whether lung ultrasound (LUS) may early predict the failure of non-invasive respiratory support (high-flow nasal cannula-HFNC, continuous positive airway pressure-CPAP, non-invasive ventilation-NIV) in hypoxemic patients. METHODS: In this prospective multicenter international observational study, we enrolled patients undergoing non-invasive treatments for hypoxemia (PaO RESULTS: We studied 100 patients (age 70 [57-76] years; female sex 39%; supports: 13 HFNC, 68 CPAP, 19 NIV); the overall rate of treatment failure was 22%. At the baseline, clinical and ultrasound parameters were similar in failing and non-failing patients; after 2 h, failing patients had lower PaO CONCLUSIONS: Changes in LUS aeration scores induced by 2 h of non-invasive respiratory support help early predict the risk of treatment failure. LUS score improved only in responders and was an independent predictor of failure.
2. Hospitalization Outcomes of Full-Term and Premature Children Aged Less Than 2 Years Hospitalized With RSV.
In 5,844 RSV hospitalizations in children <2 years, prematurity comprised 20.8% (6.6% with BPD). Premature infants under 6 months had significantly higher adjusted risks of prolonged stay (aRR 1.3), ICU admission (aRR 1.4), and assisted ventilation (aRR 2.0) versus term peers. Premature children with BPD remained at increased risk of prolonged hospitalization up to 23 months.
Impact: Provides contemporary, population-based risk estimates quantifying the added burden of prematurity and BPD on RSV hospitalization severity, informing prioritization for immunoprophylaxis and intensive monitoring.
Clinical Implications: Premature infants—especially those with BPD—should be prioritized for RSV prevention (e.g., nirsevimab), early escalation thresholds, and enhanced monitoring during early infancy.
Key Findings
- Among 5,844 RSV hospitalizations in children <2 years, 20.8% were premature; 6.6% of premature children had BPD.
- At <6 months, prematurity increased adjusted risks of prolonged hospitalization (aRR 1.3), ICU admission (aRR 1.4), and assisted ventilation (aRR 2.0) versus term children.
- Premature children with BPD had persistent risk of prolonged hospitalization through 23 months.
Methodological Strengths
- Population-based surveillance across 7 centers with robust-variance Poisson regression
- Age-stratified and BPD-stratified risk estimates adjusted for site and palivizumab
Limitations
- Observational design with potential residual confounding and misclassification
- In-hospital outcomes only; outpatient course and long-term sequelae not captured
Future Directions: Linkage with immunoprophylaxis records and long-term follow-up to assess sequelae; evaluate targeted prevention strategies in high-risk premature subgroups.
BACKGROUND: Prematurity may place young children at increased risk for severe respiratory syncytial virus (RSV) disease because of differences in lung development. We describe characteristics of children aged less than 2 years hospitalized with RSV by prematurity and bronchopulmonary dysplasia (BPD) status and examine both as risk factors for severe in-hospital outcomes. METHODS: During 2016-2023, population-based surveillance was conducted at 7 medical centers for hospitalizations with RSV-associated acute respiratory illness in children. Poisson regression with robust variance was used to estimate adjusted relative risks (aRRs) of prolonged hospitalization (≥3 days), intensive care unit (ICU) admission, and assisted ventilation by age in children with prematurity without and with BPD compared with term children after adjustment for surveillance site and palivizumab receipt. RESULTS: Among 5844 children, 4626 (79.2%) were term and 1218 (20.8%) were premature, including 1138 (93.4%) without BPD and 80 (6.6%) with BPD. Compared with term children, all premature children had greater risks for prolonged hospitalization (aRR = 1.3; 95% CI, 1.2-1.5), ICU admission (aRR = 1.4; 95% CI, 1.2-1.6), and assisted ventilation (aRR = 2.0; 95% CI, 1.4-2.8) at chronological age less than 6 months. Premature children with BPD also had greater risk for prolonged hospitalization at all ages through 23 months. CONCLUSIONS: Premature children accounted for 1 in 5 hospitalizations among children aged less than 2 years hospitalized with RSV. Compared with term children, all premature children had increased risk for severe in-hospital outcomes in early infancy, and those with BPD remained at increased risk of prolonged hospitalization through age 23 months.
3. Reduced Emergency Department Visits and Hospitalizations in Infants after Universal Respiratory Syncytial Virus Immunization, Italy, 2024-25.
In the first season of universal nirsevimab immunization, infant ED visits and hospitalizations for RSV and lower respiratory infections dropped by roughly 43–55%, while no declines occurred in 1–5-year-olds. Interrupted time series analysis against historical trends supports a program effect.
Impact: Delivers real-world, population-level evidence that universal infant immunization with nirsevimab substantially reduces severe RSV-related healthcare utilization after rollout.
Clinical Implications: Supports universal infant RSV immunoprophylaxis to reduce seasonal burden on EDs and hospitals; informs timing, scale-up, and resource planning for immunization programs.
Key Findings
- Among infants <12 months, ED visits for ALRI fell by 42.7% and hospitalizations by 46.5% during the 2024–25 season.
- RSV-specific ED visits and hospitalizations in infants decreased by 49.3% and 55.0%, respectively.
- No reductions were observed among children 1–5 years (non-eligible group), supporting a program effect rather than reduced circulation.
Methodological Strengths
- Interrupted time series against historical baselines with an age-based comparison group
- Syndromic surveillance covering ED visits and hospitalizations at population scale
Limitations
- Ecological observational design without individual-level immunization linkage
- Single region and single season; generalizability and durability require confirmation
Future Directions: Link individual immunization records, assess equity and subgroup effects, and evaluate multi-season durability and cost-effectiveness.
During the 2024-25 winter season, a universal immunization campaign with nirsevimab was implemented in a region of Italy to prevent respiratory syncytial virus (RSV) infection among infants <12 months of age. We assessed its effects using regional syndromic surveillance data on emergency department visits (EDVs) and hospitalizations for lower respiratory tract infections and RSV infections. We estimated expected burden using an interrupted time series analysis, based on historical trends, and observed values with predictions. Children 1-5 years of age, not eligible for immunization, served as a comparison group. Among infants, EDVs for acute lower respiratory tract infections decreased by 42.7% and hospitalizations decreased by 46.5%, whereas EDVs for RSV infection decreased by 49.3% and hospitalizations decreased by 55.0%. No reductions were observed in children 1-5 years of age, confirming ongoing RSV circulation. Our findings support the effectiveness of universal nirsevimab immunization in reducing severe RSV-related outcomes among infants.