Daily Respiratory Research Analysis

BACKGROUND: Whether anticoagulation alone is an adequate treatment for acute, intermediate-risk pulmonary embolism is uncertain. METHODS: We conducted a multinational, adaptive-design trial with blinded outcome adjudication. Patients with intermediate-risk pulmonary embolism (with a ratio of right ventricular end-diastolic diameter to left ventricular end-diastolic diameter of ≥1.0 and an elevated troponin level) were eligible if they had at least two indicators of cardiorespiratory distress (systolic blood pressure of ≤110 mm Hg, a heart rate of ≥100 beats per minute, or a respiratory rate of >20 breaths per minute). Patients were randomly assigned to undergo ultrasound-facilitated, catheter-directed fibrinolysis with alteplase plus anticoagulation (the intervention group) or anticoagulation alone (the control group) according to prespecified treatment protocols. The primary outcome was a composite of pulmonary embolism-related death, cardiorespiratory decompensation or collapse, or symptomatic recurrence of pulmonary embolism within 7 days. RESULTS: The intention-to-treat population comprised 544 patients: 273 in the intervention group and 271 in the control group. The mean (±SD) age was 58.2±13.5 years, and 42.6% of the patients were women. A primary-outcome event occurred in 11 patients (4.0%; 95% confidence interval [CI], 2.3 to 7.1) in the intervention group and 28 (10.3%; 95% CI, 7.2 to 14.5) in the control group (relative risk, 0.39; 95% CI, 0.20 to 0.77; P = 0.005). The effect was driven primarily by a lower risk of cardiorespiratory decompensation or collapse in the intervention group. Major bleeding occurred within 7 days after randomization in 11 patients (4.1%) in the intervention group and 6 (2.2%) in the control group (P = 0.32); major bleeding occurred within 30 days in 11 patients (4.1%) and 8 patients (3.0%), respectively (P = 0.64). No substantial between-group differences in the incidence of other serious adverse events were observed up to 30 days after randomization; no intracranial hemorrhage occurred. CONCLUSIONS: In patients with acute, intermediate-risk pulmonary embolism, ultrasound-facilitated, catheter-directed fibrinolysis plus anticoagulation led to a lower risk of the composite of pulmonary embolism-related death, cardiopulmonary decompensation or collapse, or symptomatic recurrence of pulmonary embolism within 7 days than anticoagulation alone. (Funded by Boston Scientific; HI-PEITHO ClinicalTrials.gov number, NCT04790370.).

BACKGROUND: Human respiratory syncytial virus (hRSV) is a major cause of respiratory tract infections in children worldwide. This study aims to describe the prevalence of hRSV in pediatric patients with respiratory tract infections, clarifying its association with such infections. METHODS: We analyzed studies from PubMed, Scopus, and Web of Science up to August 15, 2025, focusing on polymerase chain reaction-confirmed cases in children under 18 years. Data from 539 studies (584 datasets) were included. Pooled prevalence was calculated using a random-effects model, with subgroup analyses by region, gender, age group, sampling time, type of respiratory disease, types of patient care, genotypes, and subtypes of hRSV. Odds ratios evaluated the association between hRSV infection and respiratory disease risk. FINDINGS: The global prevalence among 1,733,341 children was 21.6%, with the highest rates in children aged less than 6 months (33.8%), and inpatients (25.9%). Bronchiolitis showed the highest prevalence (56.9%). Prevalence declined over time, possibly due to the coronavirus disease 2019 pandemic. hRSV-A (55.7%) was more common than hRSV-B (44.3%). Infection significantly increased respiratory infection risk (odds ratio = 7.0), especially for lower respiratory infections. INTERPRETATION: hRSV is a key contributor to pediatric respiratory tract infections, with notable variations by age and region. Prevention strategies, including vaccines and monoclonal antibodies, are urgently needed for high-risk groups. FUNDING: None.

INTRODUCTION: Mechanical power (MP) quantifies the energy delivered from a ventilator to the respiratory system and is a key contributor to ventilator-induced lung injury. This study evaluated the association between MP and mortality in patients with acute respiratory distress syndrome (ARDS), and examined whether this relationship differs across data-driven ARDS phenotypes. METHODS: Patients with ARDS requiring invasive ventilation were identified from the MIMIC-IV database. The association between MP and mortality was assessed using logistic regression, Kaplan-Meier survival analysis, and Cox proportional hazards models. The optimal MP threshold was determined using maximally selected rank statistics. Unsupervised clustering was used to identify ARDS phenotypes and evaluate phenotype-specific responses to MP. RESULTS: A total of 1,333 patients were included. An MP < 18.7 J/min was associated with significantly lower 28-day mortality. Among MP components, the elastic-dynamic component showed the strongest association with mortality; the elastic-static component had a weaker association, and the resistive component was not significant. Respiratory rate was the strongest predictor of mortality. Three phenotypes were identified. Phenotype I (mechanical stress-dominant): poor respiratory mechanics and the highest mortality. Phenotype II (oxygenation-preserved with mild inflammation): better oxygenation, less organ dysfunction, and the lowest mortality. Phenotype III (systemic hyperinflammation with metabolic dysregulation): significant laboratory abnormalities, strong association with high MP, and increased mortality. DISCUSSION: High mechanical power (MP) was independently associated with increased mortality in patients with ARDS. An MP threshold of 18.7 J/min demonstrated prognostic relevance for mortality risk stratification, and the association between MP and outcomes varied across ARDS phenotypes, highlighting the potential value of phenotype-informed ventilation strategies.