Daily Respiratory Research Analysis

BACKGROUND: Residual neuromuscular blockade (rNMB) after surgery can lead to complications such as respiratory distress, increased length of hospital stay, and higher healthcare costs. Sugammadex, a selective relaxant-binding agent, has shown efficacy in reversing rocuronium-induced neuromuscular blockade more rapidly than neostigmine. This study aimed to evaluate the effectiveness of a low dose of sugammadex (0.5 mg.kg METHODS: This randomized, double-blind, controlled trial included adult patients undergoing surgery with rocuronium-induced moderate neuromuscular blockade. Participants were randomized to receive either low-dose sugammadex or standard-dose neostigmine with glycopyrrolate at the end of surgery. The primary outcome was the time to achieve a Train-of-Four (TOF) ratio of ≥ 0.9 after administration of the reversal agent. Secondary outcomes included extubation time, incidence of sugammadex rescue therapy for incomplete reversal, and postoperative complications. Statistical analysis used t-tests and Mann-Whitney-Wilcoxon tests for continuous variables and chi-square tests for categorical variables, with significance set at p < 0.05. RESULTS: The median time to reach TOF ratio of ≥ 0.9 was significantly shorter in the sugammadex group (4.3 min, IQR: 3.2-6) compared to the neostigmine group (20.6 min, IQR: 10.1-21.3, p < 0.001). Extubation times were also reduced with sugammadex, with a median of 11.6 (IQR: 8.6-15.1) minutes versus 25.9 (IQR: 17.7-29.7) minutes in the neostigmine group (p < 0.001). Only 4.8% of patients in the sugammadex group required rescue therapy to reverse the neuromuscular block with TOF ratio of ≥ 0.9, compared to 60.6% in the neostigmine group (p < 0.001). No significant differences were observed in postoperative respiratory complications or PACU length of stay. CONCLUSIONS: Low-dose sugammadex provides a faster and more reliable reversal of moderate neuromuscular blockade than standard-dose neostigmine, with implications for improved operating room efficiency and patient safety. Continuous neuromuscular monitoring remains essential, as a small proportion of patients may still require additional intervention. TRIAL REGISTRATION: Registered retrospectively at ClinicalTrials.gov with registration number NCT05718934 on 2023-02-08.

OBJECTIVE: To evaluate the performance and limitations of an emergency department (ED)-based syndromic surveillance (SyS) model for detecting respiratory infection outbreaks in Korea, across distinct age groups and epidemiological contexts before and during the COVID-19 pandemic. METHODS: We conducted a retrospective time-series analysis using nationwide data from Level 1 and 2 EDs between January 2017 and December 2022. Syndromic visits were defined as those with fever (≥38.0 °C) or respiratory symptoms. Age-stratified autoregressive integrated moving average (ARIMA) models were trained on data from January 2017-December 2018 and January 2020-December 2021 to forecast syndromic ED visits in January-December 2019 and January-December 2022, respectively. Alarms were triggered when observed visit counts exceeded both the model's 95th percentile prediction interval and historical day-of-week thresholds. Alarm performance was assessed against ED discharge diagnoses of respiratory infectious diseases. RESULTS: The system performed well under stable pre-pandemic conditions, particularly among children aged 0-4 years (3-day alarm sensitivity: 1.000; specificity: 0.964), and moderately among adults aged 65 years and older. In contrast, model performance deteriorated in 2022 under pandemic conditions, especially among adults aged 20-64 years, with alarm sensitivity dropping below 0.300. The decline was driven by persistently elevated syndromic activity during the Omicron wave, which overwhelmed the static thresholds of the ARIMA models. CONCLUSION: ED-based SyS can offer timely and specific early warning for seasonal respiratory outbreaks, particularly in pediatric populations. However, its utility is limited during sustained pandemic waves. Future surveillance systems must incorporate adaptive models, dynamic thresholds, and multiple data streams to remain effective under evolving epidemiological baselines.

BACKGROUND: The predictive role of baseline tumor size (BTS) in advanced NSCLC treated with immune checkpoint inhibitors (ICIs) is unclear. We investigated its impact on ICI efficacy stratified by PD-L1 expression. METHODS: We retrospectively analyzed advanced NSCLC patients without driver mutations who received anti-PD-(L)1 therapy, with or without chemotherapy. The association between BTS and progression-free survival (PFS) was assessed according to tumor proportion score (TPS). RESULTS: A total of 423 patients were included, of whom 314 received ICI monotherapy, and 109 received chemoimmunotherapy. In the monotherapy group, patients with small tumors (<98 mm) exhibited significantly longer PFS compared to those with large tumors (≥98 mm) (7.1 vs. 2.3 months; p = 0.01). This trend was most pronounced in patients with TPS 1-49% receiving monotherapy (PFS: 4.9 vs. 1.3 months; p < 0.001). BTS was not significantly associated with PFS in the TPS ≥50% or <1% subgroups within the monotherapy cohort. However, in the chemoimmunotherapy group, PFS did not significantly differ between small and large tumors (7.1 vs. 5.5 months; p = 0.78). In the chemoimmunotherapy group, BTS significantly influenced PFS only in the TPS <1% subgroup (PFS 9.5 vs. 5.3 months; p = 0.03), but not in those with TPS ≥50% or 1-49%. DISCUSSION: BTS was a significant predictor of ICI monotherapy efficacy in patients with TPS 1-49%. Patients with large tumors and intermediate PD-L1 expression derived limited benefit from monotherapy, suggesting that chemoimmunotherapy may be more effective in this subgroup.