Pulmonology

Prophylactic NIV plus HFNC reduces reintubation in high‑risk, non‑hypercapnic ICU patients

In this pooled post hoc analysis of two multicenter trials, 829 high‑risk, non‑hypercapnic adults were managed after extubation with NIV+HFNC or HFNC alone. NIV alternating with HFNC reduced 7‑day reintubation from 17.6% to 11.8% (absolute difference −5.8%, 95% CI −11.2 to −0.8). Benefits persisted at 48 and 72 hours and through ICU discharge, indicating durable protection against early extubation failure. G‑computation confirmed a similar causal effect size, supporting routine prophylactic NIV in high‑risk, non‑hypercapnic extubations. 1

Individualized PEEP during minimally invasive surgery cuts postoperative pulmonary complications

This systematic review and meta‑analysis included 30 studies with 3,295 patients undergoing minimally invasive thoracic or abdominal surgery. Individualized PEEP strategies reduced postoperative pulmonary complications versus standard lung‑protective ventilation (RR 0.67, 95% CI 0.56–0.79). They also lowered driving pressures by about 3 cmH₂O, suggesting a mechanistic link via reduced ventilator‑induced lung stress. Findings were consistent across surgical types, with moderate certainty of evidence and low overall risk of bias. 2

SABA overuse in asthma linked to higher MACE and mortality

Using Taiwan’s national asthma pay‑for‑performance database, 231,970 adults with asthma were followed from 2011–2019. SABA overuse (≥3 canisters/year) was associated with higher 1‑year MACE than acceptable use (2.82 vs 0.99 per 100 person‑years; aHR 1.25, 95% CI 1.12–1.39). Overuse increased risks of non‑fatal MI, ischemic stroke, and all‑cause mortality, but not hemorrhagic stroke. MACE risk rose non‑linearly with SABA use, peaking at 6–8 canisters annually, underscoring the need to curb reliever overreliance. 3

Traffic‑related pollutants drive incident adult‑onset asthma and COPD in Denmark

This nationwide cohort followed 3.2 million Danish adults ≥30 years for incident hospital‑diagnosed asthma and COPD and obstructive airway medication starts. Interquartile increases in PM2.5, NO₂, and black carbon were each associated with higher asthma and COPD incidence. Associations with NO₂ and black carbon remained robust after adjusting for PM2.5, while PM2.5 associations attenuated or disappeared. Results highlight combustion‑related pollution, especially traffic emissions, as key modifiable drivers of adult‑onset obstructive lung disease. 4