BACKGROUND This document updates previously published Clinical Practice Guidelines for the management of patients with acute respiratory distress syndrome (ARDS), incorporating new evidence addressing the use of corticosteroids, venovenous extracorporeal membrane oxygenation, neuromuscular blocking agents, and positive end-expiratory pressure (PEEP). METHODS We summarized evidence addressing four "PICO

RATIONALE The respiratory mechanisms of a successful transition of preterm infants after birth are largely unknown. OBJECTIVES To describe intrapulmonary gas flows during different breathing patterns directly after birth Methods: Analysis of electrical impedance tomography (EIT) data from a previous randomized trial in preterm infants 26-32 weeks gestational age. EIT data for individual breaths were

BACKGROUND The prevalence and diagnostic utility of bronchodilator responsiveness (BDR) in a real-life setting is unclear. We explored this uncertainty in patients aged ≥12 years with physician-assigned diagnoses of asthma, asthma and COPD, or COPD in NOVELTY, a prospective cohort study in primary and secondary care in 18 countries. METHODS The proportion of patients with a positive BDR test in each

RATIONALE Particulate matter ≤2.5μm (PM2.5) is associated with adverse outcomes in fibrotic interstitial lung disease (fILD), but the impact of ultrafine particulates (UFPs; aerodynamic diameter ≤100nm) remains unknown. OBJECTIVE To evaluate UFP associations with clinical outcomes in fILD. METHODS Multicenter, prospective cohort study enrolling patients with fILD from the University of Pittsburgh Simmons

RATIONALE The impact of a household air pollution (HAP) stove intervention on child lung function is poorly described. OBJECTIVES To assess the effect of a prenatal to age one HAP stove intervention on, and exposure-response associations with, age four lung function. METHODS The Ghana Randomized Air Pollution and Health Study (GRAPHS) randomized pregnant women to a liquefied petroleum gas (LPG), improved

Rationale: Non-cystic fibrosis bronchiectasis (NCFB) may originate in bronchiolar regions of the lung. Accordingly, there is a need to characterize the morphology and molecular characteristics of NCFB bronchioles. Objective: Test the hypothesis that NCFB exhibits a major component of bronchiolar disease manifest by mucus plugging and ectasia. Methods: Morphologic criteria and region-specific epithelial

RATIONALE Previous studies investigating comorbidity impact on biologic effectiveness have been relatively small, of short duration, and have not compared biologic classes. OBJECTIVES To determine the association between T2-related comorbidities and biologic effectiveness in adults with severe asthma (SA). METHODS This cohort study used International Severe Asthma Registry data (n=21 countries, 2017-2022)

This article tells the story of our long search for the answer to one question: is stress hyperglycemia in critically illness adaptive or mal-adaptive? Our earlier work had suggested lack of hepatic insulin effect and hyperglycemia jointly predicting poor outcome. We therefore hypothesized that insulin infusion to reach normoglycemia, tight-glucose-control, improves outcome. In 3 RCTs, we found morbidity

Rationale: Acute Respiratory Distress Syndrome (ARDS) has an unacceptably high mortality rate (35%) and is without effective therapy. Orai1 is a Ca2+ channel involved in store operated Ca2+ entry (SOCE), a process that exquisitely regulates inflammation. Orai1 is considered a druggable target, but to date, no Orai1-specific inhibitors exist. Objectives: To evaluate whether ELD607, a first-in-class

RATIONALE Respiratory resistance (Rrs) and reactance (Xrs) measured by oscillometry and their intra-breath changes have emerged as sensitive parameters for detecting early pathological impairments during tidal breathing. OBJECTIVES This study evaluates the prevalence and association of abnormal oscillometry parameters with respiratory symptoms and respiratory diseases in a general adult population

RATIONALE Microplastics are a pressing global concern and inhalation of microplastic fibers has been associated with interstitial and bronchial inflammation in flock workers. However, how microplastic fibers affect the lungs is unknown. OBJECTIVES Our aim was to assess the effects of 12x31 µm nylon 6,6 (nylon) and 15x52 µm polyethylene terephthalate (polyester) textile microplastic fibers on lung epithelial

Rationale: Mounting evidence demonstrates a role for extracellular vesicles (EVs) in driving lung disorders, such as chronic obstructive pulmonary disease (COPD). Although cigarette smoke (CS) is the primary risk factor for COPD, a link between CS and the EVs that could lead to COPD is unknown. Objective: To ascertain whether exposure to CS elicits a proteolytic EV signature capable of driving disease

Rationale: IL-33 is a proinflammatory cytokine thought to play a role in the pathogenesis of asthma and chronic obstructive pulmonary disease (COPD). A recent clinical trial using an anti-IL-33 antibody showed a reduction in exacerbation and improved lung function in ex-smokers but not current smokers with COPD. Objectives: This study aimed to understand the effects of smoking status on IL-33. Methods:

Objectives: Chronic obstructive pulmonary disease (COPD) disproportionately affects low- and middle-income countries. Health systems are ill prepared to manage the increase in COPD cases. Methods: We performed a pilot effectiveness-implementation randomized field trial of a community health worker (CHW)-supported, 1-year self-management intervention in individuals with COPD grades B-D. The study took

Rationale: Chronic obstructive pulmonary disease (COPD) is associated with high morbidity, mortality, and healthcare costs. Cigarette smoke is a causative factor; however, not all heavy smokers develop COPD. Microbial colonization and infections are contributing factors to disease progression in advanced stages. Objectives: We investigated whether lower airway dysbiosis occurs in mild-to-moderate COPD

Rationale: Patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes (T2D) have worse clinical outcomes compared with patients without metabolic dysregulation. GLP-1 (glucagon-like peptide 1) receptor agonists (GLP-1RAs) reduce asthma exacerbation risk and improve FVC in patients with COPD. Objectives: To determine whether GLP-1RA use is associated with reduced COPD exacerbation

Chronic obstructive pulmonary disease is a major health problem with a high prevalence, a rising incidence, and substantial morbidity and mortality. Its course is punctuated by acute episodes of increased respiratory symptoms, termed exacerbations of chronic obstructive pulmonary disease (ECOPD). ECOPD are important events in the natural history of the disease, as they are associated with lung function

RATIONALE Lymphopenia in COVID-19 is associated with increased mortality. OBJECTIVES To explore the association between lymphopenia, host response aberrations and mortality in patients with lymphopenic COVID-19. METHODS We determined 43 plasma biomarkers reflective of four pathophysiological domains: endothelial cell and coagulation activation, inflammation and organ damage, and cytokine and chemokine

RATIONALE Definitive guidelines for anticoagulation management during veno-venous extracorporeal membrane oxygenation (VV ECMO) are lacking, while bleeding complications continue to pose major challenges. OBJECTIVES To describe anticoagulation modalities and bleeding events in adults receiving VV ECMO. METHODS International prospective observational study in 41 centers, from December 2018 to February

RATIONALE The mean pulmonary arterial wedge pressure (mPAWP) is the critical hemodynamic factor differentiating Group 1 pulmonary arterial hypertension (PAH) from Group 2 pulmonary hypertension (PH) associated with left heart disease. Despite discrepancy between the mPAWP upper physiologic-normal and current PAH definition, the implications of the initial mPAWP for PAH clinical trajectory are poorly