Purpose Heart rate variability (HRV) reflects autonomic nervous system activity and is sensitive to physiological stress induced by surgery. This study is a secondary, post hoc analysis of a randomized controlled trial aimed at evaluating changes in HRV following major and minor thoracic surgery, and investigating whether postoperative respiratory physiotherapy can modulate these changes. In a prospective, randomized design, two physiotherapy interventions, including positive expiratory pressure (PEP) and inspiratory muscle training (IMT), were compared to assess their effects on HRV. Methods Electrocardiogram recordings were analyzed from 75 patients undergoing either minor pulmonary (PM) or pulmonary resection (PR) surgery. HRV data were collected preoperatively and during the first two postoperative days, immediately following physiotherapy sessions. Patients were assigned to one of two intervention groups (PEP or IMT). Time‐, frequency‐, and nonlinear‐domain HRV parameters were analyzed longitudinally and compared between surgical and intervention groups. Results Most HRV parameters exhibited a postoperative reduction, with more pronounced changes observed in the PR surgery group. In particular, the root mean square of successive RR interval differences (RMSSD) and high‐frequency (HF) power, which are commonly associated with parasympathetic modulation, showed marked decreases. Recovery toward baseline values varied across surgical groups, interventions, and HRV parameters; however, no clear signs of recovery were observed in the PR surgery group during the observation period. No statistically significant differences were detected between the PEP and IMT interventions ( p ≥ 0.05), with the exception of short‐term detrended fluctuation analysis (DFA α 1 ) in the PM surgery group ( p = 0.04). Conclusion HRV parameters reflected surgery‐induced autonomic alterations, with more pronounced and persistent changes observed in patients undergoing PR compared with PM surgery. No clear recovery toward baseline was detected during the 2‐day postoperative follow‐up, suggesting prolonged autonomic disturbances after thoracic surgery. Trial Registration: ClinicalTrials.gov: NCT02931617
INTRODUCTION:Overweight and obesity are rising rapidly in low- and middle-income countries, including Ghana, with growing implications for respiratory health. Body mass index (BMI) influences respiratory mechanics and lung function, yet its relationship with spirometric abnormalities remains poorly characterised in sub-Saharan Africa. This study assessed the distribution of BMI and its association with spirometric patterns among patients undergoing spirometry at a tertiary respiratory centre in Ghana. METHODS:A retrospective cross-sectional study was conducted using all spirometry tests performed between 2018 and 2025 at Komfo Anokye Teaching Hospital. Demographic and anthropometric data were extracted from medical records. Spirometric patterns were classified as normal, obstructive, probable restrictive or mixed. Logistic regression was used to evaluate the association between BMI categories and obstructive and probable restrictive ventilatory defects. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. RESULTS:Among 557 spirometry tests, the median age was 42 years (IQR: 28-61 years), and 311 (55.83%) participants were female. Probable restrictive lung patterns predominated (183, 32.85%), followed by mixed (71, 12.75%) and obstructive patterns (67, 12.03%). The median BMI was 24.4 kg/m2 (IQR: 21.4-29.2 kg/m2), whereas nearly half of the participants were overweight or obese (46.31%). Obesity was more common among females than males (28.62% vs. 11.79%; p < 0.001). Crude analysis demonstrated increased odds of probable restrictive ventilatory defects among obese participants (OR = 1.87, 95% CI [1.18-2.96], p = 0.007), but this association was attenuated after adjustment (aOR = 1.45, 95% CI [0.90-2.35], p = 0.127). No BMI category was independently associated with obstructive ventilatory defects. CONCLUSION:Abnormal spirometric findings were common, with probable restrictive ventilatory defects accounting for nearly one-third of all examinations. BMI was not independently associated with obstructive or probable restrictive ventilatory defects. These findings suggest that factors beyond body mass contribute to impaired lung function in this population and highlight the need for comprehensive respiratory assessment, including lung volume measurements where feasible.
OBJECTIVE:The purpose of this study was to investigate the value of therapeutic bronchoscopy in malignant central airway obstruction (MCAO) patients secondary to non-small cell lung cancer (NSCLC), especially in those experiencing respiratory failure (RF). METHODS:This retrospective cohort study was conducted on 101 cases of NSCLC-related MCAO patients who received therapeutic bronchoscopy from January 2018 to January 2025. Patients were classified into the RF group (n = 39) and the non-RF group (n = 62) based on the presence of RF (PaO2/FiO2 ≤ 300) resulting from MCAO. RESULTS:Therapeutic bronchoscopy achieved technical success in 93.1% of 101 patients, with no significant differences in technical success (p = 0.521), complication rates (p = 0.147), and short-term or intermediate-term efficacy between RF and non-RF groups. Kaplan-Meier curves indicated a median survival of 16.98 months posttherapeutic bronchoscopy, with univariate analysis revealing statistically significant differences between the RF and non-RF groups (10.46 months vs. 18.62 months, log - rank χ2 = 4.494, p = 0.034). Multivariate Cox survival regression indicated that ECOG PS of 3-4 points (HR = 3.437, 95% CI: 1.751-6.746, p < 0.001), serum lactate dehydrogenase (LDH) ≥ 250 U/L (HR = 2.538, 95% CI: 1.328-4.852, p = 0.005), and lack of systemic antitumor treatment (HR = 3.274, 95% CI: 1.481-7.235, p = 0.003) are risk factors affecting the 2-year survival of NSCLC-related MCAO patients. Notably, the presence of secondary RF, the location, and the degree of airway stenosis in patients before surgery were not associated with the prognosis (p > 0.05). CONCLUSION:Therapeutic bronchoscopy is safe and effective in NSCLC patients with MCAO. This intervention should be performed promptly when airway narrowing causes RF. The ECOG PS, serum LDH level, and systemic antitumor treatment might be independent factors affecting the prognosis of MCAO patients.
BACKGROUND:The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation and has shown promise in assessing disease severity in chronic respiratory conditions including bronchiectasis. This study explores the association between NLR and clinical markers of bronchiectasis severity, including lung function and the Bronchiectasis Severity Index (BSI). OBJECTIVE:To assess the association between NLR, lung function, and bronchiectasis severity in adults with noncystic fibrosis bronchiectasis. METHODS:We performed a retrospective single-center study of adults with HRCT-confirmed bronchiectasis identified from electronic health records. Demographic, spirometric, microbiological, BSI, and blood count data were collected. NLR was calculated from the first available complete blood count obtained during clinical stability. Correlation analyses were performed in an outlier-truncated cohort, whereas multivariate general linear models and ordinal regression assessed independent associations with lung function and BSI severity categories. RESULTS:The cohort included 213 patients; 99 were male and 114 female, with a mean age of 53.9 ± 20.4 years. Most patients had severe bronchiectasis by BSI category. Chronic Pseudomonas aeruginosa colonization was present in 33.8% and was associated with lower FEV₁% predicted. Median NLR was 2.89. NLR showed significant negative correlations with FEV₁% predicted, FVC% predicted, and FEV₁/FVC ratio, but not with continuous BSI score. After adjustment for chronic Pseudomonas colonization, logNLR remained independently associated with FEV₁% predicted and FVC% predicted, but not with BSI score. In ordinal regression, NLR was not independently associated with BSI severity categories. Absolute eosinophil count was the only independent predictor of advanced BSI category. CONCLUSION:NLR was associated with impaired lung function, but not independently with BSI. NLR may reflect physiological impairment but does not replace established severity tools such as BSI.
BACKGROUND:Our study aims to compare patients with identified viral and bacterial pathogens and develop a predictive model for determining community-acquired pneumonia (CAP) etiology. METHODS:In this retrospective case-control study, hospitalized adults with confirmed bacterial or viral CAP were compared at a 1:3 ratio. Patients were matched by gender, hospitalization department, age, and Charlson comorbidity index. The etiology of CAP was established through blood and sputum culture, polymerase chain reaction of respiratory specimens, and urinary antigen tests. Both objective variables and subjective symptoms were assessed using multivariate conditional logistic regression. RESULTS:Our study included 400 patients. Using the best-developed model, we found that patients with bacterial CAP were more likely to exhibit unilateral infiltration on visualization (odds ratio [OR] 20.47; 95% confidence intervals [CI; 7.51-55.81], p < 0.001), experience chills (OR 20.69; 95% CI [6.08-70.38], p < 0.001), have a higher heart rate (OR 1.04; 95% CI [1.01-1.06], p = 0.001), and demonstrate an elevated neutrophils/lymphocytes ratio (OR 1.58; 95% CI [1.16-2.14], p = 0.003). They also showed a decreased level of consciousness (OR 3.16; [1.16-8.61], p = 0.024), and were more likely to receive vasopressors within the first 24 h of admission (OR 8.28; 95% CI [1.75-39.22], p = 0.008). Conversely, they were less likely to have general weakness (OR 0.20; 95% CI [0.09-0.47], p < 0.001) and tended to have lower total serum protein levels (OR 0.06; 95% CI [0.01-0.45], p = 0.006). This model showed sensitivity of 90%, specificity of 91%, and positive predictive value of 97%. CONCLUSION:The developed model offers a valuable tool for assessing the etiology of CAP upon admission.
