Pulmonology

NIV Superior to HFNO for Neuro‑Ventilatory Coupling in Hypercapnic AECOPD

This randomized crossover study enrolled 10 AECOPD patients with decompensated hypercapnic acute respiratory failure in the ICU. Thirty-minute epochs of NIV and HFNO were compared, with neural respiratory drive measured via esophageal electrodes and benchmarked to conventional oxygen therapy. NIV significantly improved neuro‑ventilatory coupling versus HFNO and produced larger reductions in inspiratory workload and work of breathing indices. Both NIV and HFNO improved neural respiratory drive efficiency compared with conventional oxygen, indicating physiologic benefit from either modality. 1

CNS Depressants Increase Hospitalization Risk in OHS Starting Home Ventilation

The DISCOVERY cohort included 3,004 obesity hypoventilation syndrome patients initiating home mechanical ventilation between 2005 and 2022. Benzodiazepines, gabapentinoids, and opioids were each associated with a higher adjusted hazard of 1‑year hospitalization or death. Hypnotics showed no clear association with the composite outcome after multivariable adjustment. The excess risk from these agents was primarily driven by increased hospitalizations rather than mortality. 2

HP-SAQE: A Quantitative Exposure Tool Discriminating HP from Other ILDs

Investigators created the HP South Asian Questionnaire for Exposure using systematic review of HP-associated exposures and Delphi consensus from 39 pulmonologists. The 50‑item tool, with qualitative and quantitative components, was derived at one center and validated across five ILD centers in India and Sri Lanka. HP-SAQE scores were significantly higher in HP than non‑HP ILD in both derivation and validation cohorts. Receiver-operating characteristic analyses showed good diagnostic performance, with validation AUC 0.858 and center-wise AUCs up to 0.967. 3