Pulmonology

Two ARF phenotypes predict prognosis and APP response

Two reproducible phenotypes were identified in non-intubated acute respiratory failure across three cohorts. Phenotype 2 had worse oxygenation, higher lactate, more coagulopathy, and higher 28-day intubation (56.7%) and mortality (22.0%) than Phenotype 1. Phenotype 1 patients derived the most benefit from prolonged awake prone positioning (significant interaction, adjusted p = 0.048). The authors provide two parsimonious prediction models for bedside phenotype assignment, but external implementation details are limited. 1

Rapid sPAP progression identifies high-risk SLE‑PAH subgroup

In 81 SLE‑PAH patients, four sPAP trajectories were derived; trajectory 4 showed high initial sPAP with rapid increase. Trajectory 4 independently predicted mortality with HR 8.843 after multivariable adjustment. Trajectory 4 correlated with higher inflammatory markers, shorter 6MWD, and greater right‑ventricular strain. Trajectory-based risk groups may inform closer monitoring and aggressive therapy in SLE‑PAH, pending broader validation. 2

Protocol: azithromycin maintenance versus placebo in young children with structural lung disease

This multicentre, double‑blind RCT will randomize 150 children (0–72 months) to azithromycin 10 mg/kg three times weekly or placebo for six winter months. Primary outcome is reduction in respiratory infections; secondary outcomes include lung function, symptoms, quality of life, and safety. The trial is powered to provide efficacy and safety data in a vulnerable pediatric population where current maintenance use lacks robust evidence. 3