Pulmonology

Driving pressure, not tidal volume, tracks 60-day mortality in ARDS, especially when etiology is pulmonary

Among 7,934 mechanically ventilated ARDS patients, 43% died by day 60. Higher driving pressure and higher respiratory rate were associated with increased 60-day mortality in both pulmonary and extrapulmonary ARDS. Driving pressure had a stronger mortality association in pulmonary versus extrapulmonary ARDS, with a significant interaction. After excluding COVID-19 cases, only driving pressure remained associated with mortality, while respiratory rate lost significance. 1

Systemic anticoagulation did not improve short-term survival in VV-ECMO for ARDS

This multicenter retrospective study evaluated 695 adults on VV-ECMO for ARDS across 24 Japanese ICUs. Propensity score–overlap–weighted analyses showed similar 28-day survival with and without systemic anticoagulation (85.8% vs 81.5%, p=0.50). Sixty-day survival, ECMO duration, circuit exchanges, bleeding complications, and transfusion volumes were also comparable between groups. Anticoagulated patients had higher mean aPTT during ECMO, confirming meaningful anticoagulation exposure. 2

Non-obstructive pre-bronchodilator spirometry safely rules out COPD in primary care adults

This CAPTURE ancillary analysis included 1,181 primary care participants with pre- and post-bronchodilator spirometry. Consistent non-obstruction occurred in 59.4% of patients, and only 2.2% had obstruction detected only post-bronchodilator. Pre-bronchodilator spirometry showed 91.3% sensitivity and 96.4% negative predictive value for post-bronchodilator obstruction, with 79.5% specificity and 60.1% positive predictive value. Using GOLD 2025 guidance, non-obstructive pre-bronchodilator results can routinely rule out COPD in primary care with few missed diagnoses. 3

Upfront nintedanib, tacrolimus, and low-dose steroids improved FVC trajectory in untreated progressive pulmonary fibrosis

The multicenter single-arm TOP-ILD phase 2 trial enrolled 34 previously untreated patients with progressive pulmonary fibrosis from varied ILD etiologies. Tacrolimus and prednisolone were started on day 1, with nintedanib added on day 8 and tacrolimus titrated to trough levels. The relative FVC% predicted slope improved from a pre-treatment decline of −20.9% per year to a post-treatment increase of +11.2% per year. Patients with higher BAL lymphocytes or elevated blood biomarkers showed greater improvement in lung function trajectory. 4