BACKGROUND:The IntelliSync+ [IS+] algorithm provides closed-loop synchronization by continuously analyzing airway pressure and flow waveforms in real time to optimize inspiratory and expiratory cycling. This study evaluated the efficacy of IS+ compared with conventional physician-tailored synchronization during noninvasive ventilation [NIV] in spontaneously breathing adult patients with ARF. METHODS:This multicenter, prospective, randomized controlled, single-blind crossover trial was conducted between March 2024 and May 2025 in two tertiary hospitals. Adult patients receiving NIV for ARF were randomized to start with either conventional synchronization or IS+. Each mode was applied for 30 min, separated by a 15-min washout period. The primary outcome was the Asynchrony Index [AI], defined as the number of asynchronous events per 100 breaths. RESULTS:Compared with conventional synchronization, IS+ significantly reduced the total AI [11.8 (7.9-22.4) vs. 25.5 (12.1-35.3) events/100 breaths, p < 0.001], as well as both major and minor asynchrony indices [8.3 (4.5-16.4) vs. 17.6 (7.5-25.6), p < 0.001; 3.4 (1.5-5.4) vs. 7.6 (3.4-13.6), p < 0.001, respectively]. Dyspnea scores were significantly reduced during IS+ [3 ± 1 vs. 5 ± 1, p = 0.0001], indicating improved comfort. CONCLUSIONS:Closed-loop synchronization using IS+ significantly improved patient-ventilator interaction and comfort during NIV in adults with acute respiratory failure with no adverse events observed during the study period. This study demonstrates that synchrony during NIV can be enhanced using a closed-loop algorithm alone, solely through real-time waveform analysis, without the need for additional invasive monitoring. Clinical Trials ID: NCT06357780.

Objectives Long-term outcomes of COVID-19 patients who discharge ICU are unclear. We investigated the effect of COVID-19 on lung structure, pulmonary functional, exercise capacity and quality of life in patients discharge from ICU and medical ward. Methods A prospective single-centre study conducted in PCR confirmed COVID-19 patients who has been discharged from University of Health Sciences, Dr. Suat Seren Chest Disease and Thoracic Surgery Teaching and Research Hospital between 15 January and 5 March 2021. Patients who followed up for more than 48 hours in ICU and more than 72 hours in medical ward were included the study. Computed tomography scores, pulmonary functional tests (PFT), 6-min walking distance and health related quality of life by SF-36 were compared between ICU and medical ward patients at 6 months after discharge. Results Seventy patients were included final analyses and 31 of them discharged from ICU. ICU patients had higher CT scores than non-ICU patients at admission (17 vs 11) and follow up visit (6 vs 0). Two-three of ICU patients had at least one abnormal finding at control CT. Advanced age (OR 1.08, 95% CI 1.02-1.15) and higher CT score at admission (OR 1.13, 95% CI 1.01-1.27) were risk factors for having radiological abnormalities at control CT. 90% of the patients discharged from the ICU had at least one persistent symptom. Conclusion A number of COVID-19 survivors could not fully recover after 6 months of hospital discharge. COVID-19 survivor needs to support therapies at recovery phase of the disease.

Background Alveoli tend to collapse in patients with acute respiratory distress syndrome (ARDS). Endotracheal aspiration may increase alveolar collapse due to the loss of end-expiratory lung volume (EELV). We aimed to compare the loss of EELV after open and closed suction in patients with ARDS. Methods This randomized crossover study included 20 patients receiving invasive mechanical ventilation for ARDS. Open and closed suction were applied in a random order. Lung impedance was measured using electric impedance tomography. The change in end-expiratory lung impedance (EELI) end of suction and at 1, 10, 20, and 30 min after suction, was used to represent the change in EELV. Arterial blood gas analyses and ventilatory parameters such as the plateau pressure (Pplat), driving pressure (Pdrive), and compliance of the respiratory system (CRS) were also recorded. Results Less volume loss was noted after closed suction than after open suction (mean ΔEELI: −2661 ± 1937 vs. −4415 ± 2363; mean difference: −1753, 95% CI [−2662, −844], P = 0.001). EELI returned to baseline 10 min after closed suction but did not return to baseline even 30 min after open suction. After closed suction, the Pplat and Pdrive decreased while the CRS increased. Conversely, the Pplat and Pdrive increased while the CRS decreased after open suction. Conclusions Endotracheal aspiration may result in alveolar collapse due to loss of EELV. Given that closed suction is associated with less volume loss at end-expiration without worsening ventilatory parameters, it should be chosen over open suction in patients with ARDS.

Aim: Predicting mortality is important for intensivists, yet conventional disease severity scores may not consistently predict mortality in patients with Coronavirus Disease 2019 (COVID-19). We aimed to develop a machine learning -based mortality prediction model for COVID-19 patients admitted to the intensive care unit (ICU). Study Design: This study employs a retrospective and prospective longitudinal design. We retrospectively screened a total of 436 COVID-19 patients admitted to the ICU between March 15, 2020, and December 31, 2021. The worst laboratory results and vital signs within the first 24 hours of ICU admission were recorded. We selected 29 inputs to develop a model using machine learning (ML), employing an artificial neural network (ANN) as the decision model. For model testing, we prospectively followed 108 patients from January 1, 2022, to March 31, 2022. Results: Our model predicted mortality with an 88% sensitivity and specificity. Conventional disease severity scores predicted mortality with lower sensitivity and specificity than our model did: 71% sensitivity and 70% specificity for the Acute Physiology and Chronic Health Evaluation II (APACHE -2), and 75% sensitivity and 75% specificity for both the Simplified Acute Physiology Score II (SAPS -2) and APACHE -4. Our model demonstrated greater discriminative power for mortality with an area under the curve (AUC) of 0.93 (95% confidence interval [CI], 0.87-0.98) compared to conventional disease severity scores. Respiratory support within the first 24 hours of ICU admission was identified as the most important factor affecting mortality. Conclusions: In scenarios such as epidemics, where conventional disease scores fall short in predicting mortality, machine learning models can be developed to reliably forecast disease outcomes.

Objective: To compare the effects of a home- based pulmonary rehabilitation (PR) program with and without telecoaching on health- related outcomes in COVID-19 survivors. Methods: A total of 42 COVID-19 patients who completed medical treatment were randomly divided into two groups: the study (telecoaching) group (n = 21) and the control (no telecoaching) group (n = 21). Both groups participated in an 8-week home-based PR program including education, breathing exercises, strength training, and regular walking. The study group received phone calls from a physiotherapist once a week. Both groups of patients were assessed before and after the program by means of the following: pulmonary function tests; the modified Medical Research Council dyspnea scale; the six-minute walk test; extremity muscle strength measurement; the Saint George's Respiratory Questionnaire (to assess disease-related quality of life); the Medical Outcomes Study 36-item ShortForm Health Survey (SF- 36, to assess overall quality of life); and the Hospital Anxiety and Depression Scale. Results: In both groups, there were significant improvements in the following: FVC; the six-minute walk distance; right and left deltoid muscle strength; Saint George's Respiratory Questionnaire activity domain, impact domain, and total scores; and SF-36 social functioning, role-physical, role-emotional, and bodily pain domain scores (p < 0.05). Decreases in daily-life dyspnea, exertional dyspnea, and exertional fatigue were significant in the study group (p < 0.05), and the improvement in SF-36 social functioning domain scores was greater in the study group (p < 0.05). Conclusions: A home- based PR program with telecoaching increases social functioning and decreases daily- life dyspnea, exertional dyspnea, and exertional fatigue in COVID-19 survivors in comparison with a home- based PR program without telecoaching.

OBJECTIVE:Early pulmonary rehabilitation (PR) and acute and post-acute mobilization with telemonitoring and telerehabilitation (TR) have been recommended for coronavirus disease 2019 (COVID-19) patients. We aimed to compare the duration of weaning from oxygen in patients with hypoxemic COVID-19 who received PR and those who did not.MATERIAL AND METHODS:This study was designed as a quasi-experimental study and was conducted on patients discharged with oxygen supplementation between December 2021 and May 2022. They were compared with patients who received PR and those who did not in terms of the duration of oxygen use.RESULTS:A total of 61 patients (9 women in each group) completed the study. The mean age was 65 ± 12. Thirty patients underwent PR (group 1) and the remaining 31 patients were classified as control group (group 2). When the groups were compared in terms of duration of oxygen use, patients who performed PR were statistically significant shorter duration than those who did not (P = .012). In addition, PR improved their quality of life compared to group 2.CONCLUSION:It was concluded that although PR has many indications, it is also effective, feasible, and safe in prolonged infections and it was thought that TR may also be effective as supervised PR.

Introduction Studies focus on pathogenesis, clinical manifestations, and complications during the early phase of the coronavirus disease-19 (COVID-19). Long-term outcomes of COVID-19 patients who discharge intensive care unit (ICU) are unclear. Objectives We investigated the effect of COVID-19 on lung structure, pulmonary functional, exercise capacity and quality of life in patients discharge from ICU and medical ward. Methods A prospective single-centre study conducted in PCR confirmed COVID-19 patients who has been discharged from University of Health Sciences, Dr. Suat Seren Chest Disease and Thoracic Surgery Teaching and Research Hospital between 15 January and 5 March 2021. Patients who followed up for more than 48 hours in ICU and more than 72 hours in medical ward were included the study. Computed tomography scores, pulmonary functional tests (PFT), 6-min walking distance and health related quality of life by SF-36 were compared between ICU and medical ward patients at 6 months after discharge. Results Seventy patients were included final analyses and 31 of them discharged from ICU. ICU patients had higher CT scores than non-ICU patients at admission (17 vs 11) and follow up visit (6 vs 0). Two-three of ICU patients had at least one abnormal finding at control CT. Advanced age (OR 1.08, 95% CI 1.02-1.15) and higher CT score at admission (OR 1.13, 95% CI 1.01-1.27) were risk factors for having radiological abnormalities at control CT. Conclusion A number of COVID-19 survivors especially with severe disease could not fully recover after 6 months of hospital discharge.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a disease caused by airway and/or parenchymal pathology. Therefore, some patients inevitably have chronic bronchitis and some patients have emphysema. The current thinking is that exercise affects these two major phenotypes differently. In this study, we investigated the benefits of pulmonary rehabilitation (PR) in chronic bronchitis- and emphysema-predominant COPD patients. METHODS: Retrospective data of chronic bronchitis- and emphysema-predominant COPD patients who completed an outpatient 8-week PR program between the years 2013 and 2017 in the PR unit of our hospital were examined. Demographic data (age, sex, body mass index, smoking history, long-term oxygen therapy, noninvasive ventilation, emergency admissions, and number of hospitalizations) were recorded. The patients were divided into two groups: chronic bronchitis predominant and emphysema predominant. Patients were assigned to the emphysema-predominant group based on radiology results. Patients were assigned to the chronic bronchitis-predominant group according to clinical description. The two groups were compared using the recorded data cited above. RESULTS: Of the 146 patients, 85 (58.2%) were assigned to the emphysema-predominant group and 61 (41.8%) were assigned to the chronic bronchitis-predominant group. There was no difference between the two groups in age and gender. Pulmonary function test (PFT) parameters (forced expiratory volume in 1 s and diffusing capacity of the lungs for carbon monoxide (DLCO)), arterial blood gas values (pO2, PCO2, and SpO2), 6 min of walking time, and quality of life scores were significantly improved after PR. However, there was no difference between the emphysema- and chronic bronchitis-predominant groups in terms of the improvements after PR. CONCLUSION: In this study, it was observed that the improvement due to PR seen in COPD patients was independent of phenotype. Therefore, all COPD patients should be encouraged to participate in PR programs regardless of their phenotypes.

Background: This study aims to investigate the effects of preoperative physiotherapy education on hospital stay and postoperative complications in patients undergoing thoracic surgery. Methods: This retrospective study included a total of 96 patients who underwent lobectomy or pneumonectomy for a bronchial carcinoma or metastatic lung disease (84 males, 12 females; median age 60 years; interquartile range 55-67 years) between September 2012 and September 2013. A novel preoperative physiotherapy education protocol was developed by the pulmonary rehabilitation unit and thoracic surgery department of our hospital for patients undergoing thoracic surgery. Of the patients, 49 were applied preoperative physiotherapy education and 47 were not applied. Outcomes of patients who were applied or not preoperative physiotherapy education protocol during a six-month period were compared. Results: The length of hospital stay and postoperative complication rates were similar between the groups (p>0.05). In preoperative physiotherapy education group, the number of days between the date of education and operation was found to be negatively correlated with the length of hospital stay and the postoperative complication rates (p<0.05). Conclusion: Our study results suggest that physiotherapy education should start as early as possible before lung surgery and this protocol is associated with shorter hospital stay and lower postoperative complication rate.