Chronic obstructive pulmonary disease (COPD) is a heterogenous lung condition characterized by progressive airflow obstruction. Despite advancements in diagnosis and treatment, the disease burden remains high; although clinical trials have shown improvements in outcomes such as exacerbations, quality of life, and lung function, improvement may not be attainable for many patients. For patients who do

RATIONALE No systematic investigation into dyspnea in patients receiving prolonged ventilation (>21 days) after recovering from critical-illness has been published. OBJECTIVES To determine magnitude, nature and pathophysiological basis of dyspnea during an unassisted-breathing trial in prolonged-ventilation patients. METHODS Dyspnea intensity and descriptor selection were investigated in 27 prolonged-ventilation

RATIONALE High flow therapy reduces dyspnea in acute respiratory failure but the underlying mechanisms are not fully elucidated. OBJECTIVES To compare dyspnea, airway occlusion pressure (P0.1) and inspiratory work with and without nasal high flow (NHF, FiO2 21%, temperature 31°C) in intubated patients under pressure support ventilation and during a spontaneous breathing trial (SBT). METHODS Dyspnea

RATIONALE Unrecognised coronary artery disease (CAD) may contribute to adverse outcomes in chronic obstructive pulmonary disease (COPD). Improved identification of at-risk groups could inform better preventative care. We aimed to evaluate the burden and relationships of radiologically detectable CAD in COPD, establish frequency of occult disease, and examine potential cardiovascular screening methods

Rationale: C-reactive protein (CRP)-based tuberculosis (TB) screening is recommended for people with HIV (PWH). However, its performance among people without HIV and in diverse settings is unknown. Objectives: In a multi-country study, we aimed to determine whether CRP meets the minimum accuracy targets (sensitivity ≥90%, specificity ≥70%) for an effective TB screening test. Methods/Measurements: Consecutive

RATIONALE Systemic molecular phenotypes of critical illness are prognostically informative, yet their temporal kinetics and implications of changing phenotypes remain incompletely understood. OBJECTIVES To determine the temporal nature of the Hyperinflammatory and Hypoinflammatory phenotypes and assess the impact of transition between the phenotypes on mortality. METHODS We used data from one prospective

RATIONALE Race-based estimates of pulmonary function in children could influence the evaluation of asthma in children from racial and ethnic minoritized backgrounds. OBJECTIVES To determine if race-neutral (GLI-Global) versus race-specific (GLI-Race-Specific) reference equations differentially impact spirometry evaluation of childhood asthma. METHODS The analysis included 8,719 children aged 5 to <12

RATIONALE Idiopathic Pulmonary Fibrosis (IPF) is a lethal disease with limited therapeutic options. FGF21, an endocrine fibroblast growth factor that acts through the FGFR1/KLB pathway, mitigates liver fibrosis. OBJECTIVES We hypothesized that FGF21 could exert anti-fibrotic properties in the lung. METHODS The concentrations of FGF21 and KLB in the plasma of IPF patients and control subjects were assessed

RATIONALE Corticosteroid-responsive type 2 (T2) inflammation underlies the T2-high asthma endotype. However, we hypothesized that type 1 (T1) inflammation, possibly related to viral infection, may also influence corticosteroid response. OBJECTIVES To determine the frequency and within-patient variability of T1-high, T2-high, and T1/T2-high asthma endotypes and whether virally influenced T1-high disease

RATIONALE Individuals acting as surrogate decision-makers for critically ill patients frequently struggle in this role and experience high levels of long-term psychological distress. Prior interventions designed solely to improve information sharing between clinicians and family members have been ineffective. OBJECTIVES To examine the impact of a multicomponent family support intervention on patient

RATIONALE The chronic lung disease bronchopulmonary dysplasia (BPD) remains the most common complication of extreme prematurity (<28 weeks of gestation). Umbilical cord-derived mesenchymal stromal cells (UC-MSCs) represent an opportunity for autologous cell-therapy, as UC-MSCs have been shown to improve lung function and structure in experimental BPD. However, characterization and repair capacity of

RATIONALE Whether extubation immediately after a successful spontaneous breathing trial is associated with clinical benefits in adult patients with acute brain injury is unknown. OBJECTIVES We sought to estimate the association between a prompt extubation attempt and ventilator-free days among adult patients with acute brain injury. METHODS We performed an emulation of a previously designed randomized

RATIONALE The pathophysiological relationship between fluid administration, fluid balance, and mechanical ventilation in the development of lung injury is unclear. OBJECTIVES To quantify the relative contribution of mechanical power and fluid balance in the development of lung injury. METHODS Thirty-nine healthy female pigs, divided into four groups, were ventilated for 48 hours with high (~18J/min)

Background: There is increasing interest in the use of home-based monitoring in people with chronic lung diseases to improve access to care, support patient self-management, and facilitate the collection of information for clinical care and research. However, integration of home-based monitoring into clinical and research settings requires careful consideration of test performance and other attributes

RATIONALE Inspiratory muscle training (IMT) improves respiratory muscle function in patients with weaning difficulties. IMT protocols involve performing daily sets of breaths against external loads. However, the impact of IMT on weaning outcomes while incorporating sham control interventions remains unclear. OBJECTIVES To compare the effects of a high-intensity IMT (Hi-IMT) intervention with a sham

BACKGROUND The incidence of invasive fungal infections is increasing in immune-competent and immune-compromised patients. An examination of the recent literature related to the treatment of fungal infections was performed to address two clinical questions. First, in patients with proven or probable invasive pulmonary aspergillosis, should combination therapy with a mold-active triazole plus echinocandin

BACKGROUND Pulmonary hypertension in children often progresses despite optimal therapy. This document provides an evidence-based clinical practice guideline for the management of children with progressive pulmonary hypertension despite optimal therapy. METHODS A multidisciplinary panel identified pertinent questions regarding the management of children with pulmonary hypertension that has progressed