Background National utilization and short-term outcomes of open surgical tracheostomy (OST) versus percutaneous dilatational tracheostomy (PDT) in adults hospitalized for COPD exacerbation are uncertain. Methods Adult hospitalizations not coded as elective, with a primary diagnosis of COPD exacerbation and tracheostomy, in the U.S. National Inpatient Sample (2016–2022) were classified as OST or PDT using ICD-10-PCS approach codes. Utilization trends, in-hospital mortality, length of stay (LOS), and inflation-adjusted charges were compared using survey-weighted multivariable models and inverse probability of treatment weighting (IPTW), with further adjustment for timing, coded severity, and pandemic period. Results Of an estimated 2,970 hospitalizations (594 sampled), 36.5% involved PDT. Annual volumes declined for PDT (215 to 115; P-trend=0.023) and OST (480 to 165; P-trend=0.003). In-hospital mortality was 13.5% (PDT 14.3% vs OST 13.0%; P=0.662). Mortality was higher in 2020–2022 than in 2016–2019 among OST hospitalizations (21.3% vs 10.2%; P=0.006) but not among PDT hospitalizations (18.3% vs 12.7%; P=0.29); annual trends did not differ significantly between approaches (P for interaction=0.061). After adjustment, PDT was not associated with mortality (RR, 1.06; 95% CI, 0.68–1.66), LOS (−0.63 days; 95% CI, −4.19 to 2.94), or charges (ratio, 0.98; 95% CI, 0.85–1.12); estimates were consistent with IPTW, timing and severity adjustment, exclusion of 2020, and within both periods. Conclusions Both OST and PDT volumes declined. No significant association was detected between approach and short-term outcomes, although estimates were imprecise. The mortality increase within OST hospitalizations, concentrated in the pandemic period, warrants cautious interpretation given potential changes in case mix, treatment selection, pandemic-related practice, and unmeasured severity.
Introduction Respiratory muscle impairment is common in patients with severe emphysema, primarily driven by lung hyperinflation. Endobronchial valve (EBV) treatment reduces hyperinflation and may restore respiratory mechanics in this patient population. Our aim was to investigate changes in neural drive and respiratory muscle recruitment following EBV treatment. Methods EBV-eligible emphysema patients from our prior study on diaphragm function were prospectively enrolled (NCT04735731). Respiratory muscle activation and timing were assessed using surface electromyography at baseline and 6 weeks following EBV treatment. Additionally, an age-matched control group without respiratory symptoms was included for comparison. Results We included 25 patients who underwent EBV treatment (mean FEV1 28% predicted, mean RV 233% predicted) and 12 controls. The inspiratory time (Ti) to total time of respiratory cycle (Ttot) ratio (0.35 vs 0.53; p=0.003) was significantly lower in patients compared to controls. Activity of the diaphragm (4.7 vs 0.9 µV; p<0.001) and intercostal muscles (1.2 vs 0.4 µV; p<0.001) during tidal breathing was significantly higher in patients. Furthermore, tonic (end-expiratory) activity of the diaphragm (1.4 vs 0.6 µV; p=0.012) and intercostal muscles (1.4 vs 0.6 µV; p=0.003) was significantly higher as well. Following EBV treatment, all measured outcomes improved significantly, approaching the values observed in the control group. Conclusion These findings indicate that neural drive and respiratory muscle effort are significantly elevated in severe emphysema patients. By reducing lung hyperinflation, endobronchial valve treatment reduces this load, resulting in improved respiratory mechanics and decreased work of breathing, an important contributor to dyspnoea severity.
Pulmonary hypertension associated with chronic lung disease (PH_lung) is a frequent complication of chronic obstructive pulmonary disease, interstitial lung disease, and other parenchymal lung disorders, and is associated with impaired exercise capacity, reduced quality of life and poor survival. Despite increasing recognition of its clinical importance, major challenges remain regarding early diagnosis, hemodynamic classification, and optimal treatment. Following the 7th World Symposium on Pulmonary Hypertension, a panel of experts reviewed from Germany and International collaborators summarized recent evidence and discussed unresolved issues relevant to everyday clinical practice. This review summarizes current concepts of the diagnosis and management of PH_lung, with particular emphasis on multimodal screening strategies integrating pulmonary function testing, biomarkers, echocardiography, cardiopulmonary exercise testing, and thoracic imaging to improve patient selection for right heart catheterization. We discuss practical aspects of hemodynamic assessment, overlapping phenotypes, including connective tissue disease, sarcoidosis, and the emerging pulmonary vascular “lung phenotype”, and current evidence supporting targeted therapies with emphasis on patients’ pathways in real-world settings. While inhaled treprostinil has become the first approved treatment for pulmonary hypertension associated with interstitial lung disease in several countries, no pulmonary hypertension-specific therapy is currently recommended routinely for COPD-associated PH, highlighting the need for careful patient phenotyping and individualized management in expert centres. The review further addresses indications for lung transplantation and outlines future research priorities. Earlier recognition, multidisciplinary collaboration, and continued translational and clinical research are essential to improve outcomes in this highly vulnerable patient population.
Introduction: Shape-sensing robotic-assisted bronchoscopy (ssRAB) has emerged as a promising modality for diagnosing peripheral pulmonary lesions (PPLs). This meta-analysis evaluated its diagnostic performance and safety profile. Methods: PubMed, Embase, and Cochrane Library were searched from inception to December 2025. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-3. Random-effects model was used to estimate the pooled diagnostic yield, sensitivity for malignancy, and complication, with rates (%) and 95% confidence intervals (CI) when the I2 index exceeded 50%. Cumulative meta-analysis was performed to assess the temporal stability and evidence saturation of the pooled diagnostic yield. Publication bias was evaluated using funnel plots and Egger's test. Results: A total of 3678 lesions from 18 studies were included. Notably, diagnostic yield varied significantly by outcome definition, with pooled diagnostic yield of 82.5% (95% CI: 78.3%-86.0%) under strict definition versus 88.1% (95% CI: 82.8%-92.0%) under intermediate definition (P=0.036). The pooled sensitivity for malignancy of 90.0% (95% CI: 86.4%-92.8%). Cumulative meta-analysis showed stabilized diagnostic performance after approximately 1,500 lesions for the strict definition and 500 lesions for intermediate definition. Moreover, safety profile was favorable, with pooled rates of pneumothorax 1.8% (95% CI:1.3%-2.3%), chest tube placement 1.1% (95% CI: 0.7%-1.5%), and severe bleeding 0.0% (95% CI: 0.0%-0.3%). Subgroup analyses showed consistent performance across study designs, region, and nodule characteristics. Diagnostic yield was significantly influenced by publication year, and lesion size (P<0.05). Conclusion: ssRAB was associated with favorable, definition-dependent diagnostic yield (82.5%-88.1%) with exceptional safety, supporting ssRAB as an attractive first-line minimally invasive diagnostic option in appropriately selected patients, especially for small nodules (<2cm) and patients at elevated procedural risk.
Background: Incremental cardiopulmonary exercise testing (CPET) is used to assess exercise capacity and identify mechanisms of exercise limitation. Identification of test maximality is essential for correct interpretation, yet no consensus exists on the defining criteria. This study evaluated the performance of different V˙O2 plateau definitions and the contribution of secondary maximality criteria in patients with chronic respiratory disease and healthy controls. Methods: We retrospectively analyzed 395 CPETs (84 healthy, 135 chronic obstructive pulmonary disease, 99 interstitial lung disease, 77 pulmonary hypertension), comparing consensus-based visual identification of a V˙O2 plateau by three pulmonologists with three commonly used plateau definitions. Additionally, five secondary maximality criteria were evaluated, using strict and liberal thresholds. Results: The relative V˙O2 plateau definition showed strong agreement with visual assessment (κ = 0.75–0.93), while absolute thresholds were discordant (κ = 0.02–0.31). Overlap between maximality criteria was high in healthy individuals but low in disease groups, suggesting that evaluating multiple criteria in parallel is necessary. However, combining more than 2 secondary criteria in healthy subjects and more than 3 in patients on top of V˙O2 plateau provided minimal additive value. Conclusion: CPET maximality assessment depends strongly on the criteria applied, potentially altering CPET interpretation and clinical decision-making.
