Daily Respiratory Research Analysis

BACKGROUND: Flexible bronchoscopy (FB) is commonly performed in patients with acute respiratory failure (ARF), but the procedure can exacerbate hypoxemia and increase the need for respiratory support. The impact of high-flow nasal oxygen (HFNO) therapy during nasal FB in patients with ARF remains uncertain, as prior studies have focused primarily on oxygenation rather than clinical outcomes. We aimed to evaluate whether HFNO therapy via a single-prong cannula interface (HFNO-SPC) could reduce the need for respiratory support escalation within 24 h after FB compared to standard oxygen therapy (SOT). METHODS: We conducted a two-center, open-label, randomized controlled trial comparing HFNO-SPC to SOT in patients undergoing FB. The primary outcome was escalation of respiratory support within 24 h after FB, defined as the requirement for invasive mechanical ventilation (IMV), noninvasive ventilation (NIV), or HFNO, or as increases in support parameters without changing the mode of respiratory support. The secondary outcome was a hierarchical composite of these escalation events. Electrical impedance tomography (EIT) monitoring was performed during FB to assess tidal volume and end-expiratory lung volume changes. RESULTS: A total of 160 patients were randomized to either the HFNO-SPC group (n = 80) or the SOT group (n = 80), and all were included in the intention-to-treat analysis. HFNO-SPC significantly reduced the incidence of respiratory support escalation compared to SOT (15.0% vs. 33.8%, CONCLUSIONS: In patients with ARF, HFNO-SPC significantly reduced the proportion of patients requiring respiratory support escalation within 24 h after FB compared with SOT. This finding was consistent across a hierarchical analysis of clinically ranked outcomes. TRIAL REGISTRATION: ClinicalTrials.Gov: NCT05759832. Registered 27 February 2023.

BACKGROUND: While early rehabilitation is widely implemented in intensive care units (ICUs) for patients requiring mechanical ventilation (MV), the clinical effectiveness of external diaphragm pacing (EDP) in this context remains unclear. This systematic review and meta-analysis aimed to evaluate the impact of EDP on clinical outcomes in patients receiving MV and to provide evidence to inform future research. METHODS: A comprehensive search of nine electronic databases was conducted from inception to January 2026, for randomized controlled trials (RCTs) comparing EDP with control in MV patients. Data were analyzed using Review Manager version 5.4. The risk of bias in RCTs was assessed using the Cochrane Risk of Bias tool (RoB 2.0). The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. This study followed Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. RESULTS: Fourteen RCTs involving 862 patients (430 in EDP group, 432 controls) were included. Meta-analysis revealed that EDP significantly reduced the duration of MV [mean difference (MD) =-1.51 days, 95% confidence interval (CI): -2.41 to -0.61, P=0.02], increased the rate of successful weaning [odds ratio (OR) =3.45, 95% CI: 2.14-5.56, P<0.001], and shortened ICU length of stay (MD =-2.88 days, 95% CI: -3.37 to -2.40, P<0.001). However, no significant improvement in survival was observed (OR =1.11, 95% CI: 0.69-1.79, P=0.66). Subgroup analyses indicated the greatest reduction in MV duration for patients with weaning difficulty, and heterogeneity in ICU stay was partially explained by disease type and study quality. CONCLUSIONS: EDP was associated with reduced MV duration, higher weaning success, and shorter ICU stay, but not with improved survival, in adult patients receiving MV. These findings support EDP as a beneficial adjunctive rehabilitation strategy, particularly for patients experiencing weaning difficulty. Further large-scale RCTs are warranted to confirm its effects on mortality and to optimize treatment protocols.

BACKGROUND: The combined evidence and safety of fiberoptic bronchoscopy (FB)-guided bronchial alveolar lavage (BAL) combined with topical drug administration for the treatment of severe pneumonia has not been systematically evaluated. This study aimed to systematically evaluate the efficacy and safety of FB‑guided BAL combined with local drug injection for severe pneumonia. METHODS: This study searched PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI) and Wanfang Data to collect randomized controlled trials (RCTs) published up to 10 May 2025 on the combined use of BAL and local drug injection in the treatment of patients with severe pneumonia. The primary outcome was clinical efficacy rate, with secondary outcomes including intensive care unit (ICU) length of stay, 28-day case fatality rate, and adverse events. RESULTS: A total of 30 RCTs (2,742 patients) were included. Clinical efficacy rate: significantly improved in the combination therapy group [risk ratio (RR) =1.25, 95% confidence interval (CI): 1.19-1.31, P<0.001], with the greatest relative benefit observed in the middle-aged group (RR =1.33). Subgroup analysis by drug type showed that expectorants achieved the largest absolute improvement [absolute risk difference (ARD) 23.7%], while antibiotics demonstrated the most consistent efficacy. ICU length of stay: reduced by an average of 4.73 days (95% CI: -5.57 to -3.88, P<0.001). Safety: overall adverse events showed no difference (RR =2.13, 95% CI: 0.80-5.66). In the pediatric subgroup, based on two small studies (60 patients), the estimate was highly imprecise (RR =4.74, 95% CI: 0.55-40.50). CONCLUSIONS: In adults with severe pneumonia, combined FB-BAL and local drug injection improves clinical efficacy and shortens ICU stay. Antibiotics offer consistent benefits; expectorants provide greatest absolute gain in selected patients. Pediatric evidence is limited with safety concerns. Effect on mortality remains unclear. However, all 30 included trials were conducted in China, which may limit the generalizability of findings to other healthcare settings and populations. International validation studies are warranted.