Daily Respiratory Research Analysis
Analyzed 206 papers and selected 3 impactful papers.
Summary
Three studies advance respiratory prevention and perioperative care: a BMJ systematic review maps effective non-drug strategies to reduce postoperative pulmonary complications in abdominal surgery; a nationwide case-control study in Chile shows strong real-world effectiveness of universal nirsevimab immunization in high-risk infants against RSV hospitalizations; and a large prospective cohort from The Lancet Regional Health (Western Pacific) demonstrates that a quantitative, serial ESAT6-CFP10 skin test strategy markedly improves tuberculosis risk stratification among school contacts.
Research Themes
- Perioperative pulmonary complication prevention
- RSV immunoprophylaxis effectiveness in high-risk infants
- Programmatic TB risk stratification using serial skin testing
Selected Articles
1. Non-drug perioperative interventions to reduce postoperative pulmonary complications after abdominal surgery: systematic review and meta-analysis.
Across 255 RCTs (55,260 participants), this synthesis mapped 10 classes and 39 subtypes of non-pharmacologic perioperative interventions for abdominal surgery. Postoperative pulmonary complications occurred in 11.7%, and high-certainty evidence indicated that low fraction of inspired oxygen (FiO2) reduces PPCs, establishing an evidence hierarchy for practice.
Impact: Guideline-grade synthesis with trial sequential analysis clarifies which perioperative strategies reliably prevent pulmonary complications, directly informing anesthesia and surgical protocols.
Clinical Implications: Adopt evidence-supported non-drug measures—particularly low FiO2 strategies within lung-protective bundles—to reduce PPCs after abdominal surgery; embed these into ERAS pathways and quality metrics.
Key Findings
- Included 255 RCTs with 55,260 participants across 10 intervention types and 39 subtypes.
- Overall postoperative pulmonary complication rate was 11.7% across trials.
- High-certainty evidence showed low fraction of inspired oxygen (FiO2) reduces PPCs, defining an evidence hierarchy for abdominal surgery.
Methodological Strengths
- Comprehensive RCT-only synthesis with GRADE assessment and trial sequential analysis
- Clear PPC definitions using standardized EPCO criteria
Limitations
- Heterogeneity across interventions and perioperative protocols may affect pooled estimates
- Abstract does not enumerate effect sizes for all intervention subtypes
Future Directions: Quantify comparative effectiveness between leading strategies (e.g., low FiO2 versus other components), assess implementation in ERAS bundles, and evaluate patient-centered outcomes and cost-effectiveness.
OBJECTIVE: To evaluate the effectiveness of perioperative non-drug interventions in reducing postoperative pulmonary complications (PPCs) in adults undergoing abdominal surgery. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Ovid MEDLINE, Embase, and Web of Science from database inception to January 2025 and updated in January 2026, with no language restrictions. STUDY SELECTION: Randomised controlled trials assessing the effectiveness of perioperative non-drug interventions for the prevention of PPCs in adults undergoing elective abdominal surgery under general anaesthesia, with clearly defined PPCs. MAIN OUTCOME MEASURES: The primary outcome was the proportion of patients developing PPCs. Secondary outcomes included the proportion of patients with PPC subtypes according to European Perioperative Clinical Outcome definitions (respiratory infection, respiratory failure, pleural effusion, atelectasis, or pneumothorax) and hospital length of stay. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened studies, extracted data, and assessed risk of bias with the Cochrane RoB 2.0 tool. Data were synthesised using meta-analyses and trial sequential analyses, with the evidence certainty assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS: 255 trials including 55 260 participants were included, evaluating 10 types of interventions with 39 subtypes for PPC prevention. PPCs occurred in
2. Dynamic, quantitative ESAT6-CFP10 skin test for tuberculosis risk prediction: a large-scale, multi-center, prospective cohort study.
In 73,761 school contacts, the EC (ESAT6-CFP10) skin test response size strongly predicted incident TB, with a 7% hazard increase per 1-mm rise. A serial 'test twice, take maximum' strategy outperformed single testing (C-statistic 0.806 vs 0.722), offering high specificity (96.1% at ≥5 mm) and actionable targeting of preventive therapy.
Impact: Provides a scalable, low-infrastructure risk stratification tool that improves upon single testing and can guide targeted TB preventive therapy where IGRAs are impractical.
Clinical Implications: Use serial EC testing (two measurements, take maximum) to prioritize high-risk contacts for preventive therapy; consider ≥5 mm as a practical threshold with high specificity and reasonable sensitivity.
Key Findings
- In 73,761 contacts, each 1-mm increase in EC response diameter was associated with a 7% higher TB hazard.
- Serial 'test twice, take maximum' strategy improved discrimination (C-statistic 0.806 vs 0.722 versus single test).
- At ≥5 mm, sensitivity was 65.0% and specificity 96.1%; recent converters had PPV 3.4% (NNT ~30).
- Completion of preventive therapy was strongly protective (aHR 0.17; 95% CI 0.11–0.25).
Methodological Strengths
- Very large, multi-center, prospective cohort with active surveillance and registry linkage
- Robust statistical evaluation including Cox models, ROC and PR curves
Limitations
- Generalizability may be limited to school-based contact investigations in one province
- Sensitivity remains moderate; performance in non-outbreak or adult populations needs validation
Future Directions: External validation in diverse settings (household, workplace), integration into contact-tracing workflows, and cost-effectiveness analyses compared with IGRAs.
BACKGROUND: Predicting which individuals with METHODS: We enrolled 73,761 contacts identified during school-based tuberculosis outbreaks in Jiangsu, China, from 2020 to 2024. Participants underwent baseline EC test, chest radiography, and symptom screening. EC-negative individuals were retested after 8-12 weeks. Incident tuberculosis was identified through active surveillance and registry linkage. We compared single vs. serial test strategies using Cox models, receiver operating characteristic (ROC) curves and precision-recall (PR) curves. FINDINGS: Among 73,761 close contacts, 108 had prevalent tuberculosis and 190 developed incident cases (overall incidence 151.2 per 100,000 person-years). EC response size predicted incident tuberculosis in a steep, dose-dependent manner. Each 1-mm increase in the maximum response diameter was associated with a 7% higher hazard. The serial test strategy, utilizing the maximum response from two measurements, substantially outperformed single test [C-statistic: 0.806 vs. 0.722]. At the ≥5 mm threshold, this combined strategy yielded a sensitivity of 65.0% and specificity of 96.1%. The subgroup of recent converters had a PPV of 3.4% (95% CI: 2.8-4.1), corresponding to an NNT of approximately 30, and a hazard ratio (HR) of 45.12 (95% CI: 32.50-62.63). Preventive treatment completion was strongly protective (aHR 0.17; 95% CI: 0.11-0.25). INTERPRETATION: The "test twice, take maximum" EC strategy provides superior risk stratification for tuberculosis prevention. This approach identifies high-risk contacts for targeted intervention. Despite limited sensitivity, these results suggest that quantitative EC skin testing can provide a practical alternative for programmatic risk stratification. In settings where IGRAs are constrained by cost or infrastructure, this approach may enable more efficient targeting of preventive treatment. FUNDING: National Natural Science Foundation of China (82504476, 82473693, 82574173); Jiangsu Province Preventive Medicine Research Project (Ym2023039); The Special Scientific Research Project for Talent Introduction of the First Affiliated Hospital of Wannan Medical College (KY2960YR2530); Jiangsu Province Postgraduate Research and Innovation Project (KYCX24_2061).
3. Nirsevimab in High-Risk Infants in a Respiratory Syncytial Virus Prevention Strategy.
Using nationwide matched registries after Chile’s universal rollout, nirsevimab was associated with an 84.3% reduction in RSV-related LRTI hospitalizations among at-risk infants, with strongest effects in congenital heart disease (96.3%). Extremely preterm infants did not show a statistically significant reduction as a subgroup.
Impact: Provides real-world, policy-level evidence supporting universal nirsevimab over targeted prophylaxis in high-risk infant populations.
Clinical Implications: Health systems can prioritize universal nirsevimab in RSV season, with particular emphasis on infants with congenital heart disease; monitor outcomes in extremely preterm infants where benefit estimates were imprecise.
Key Findings
- Among at-risk infants, nirsevimab was associated with 84.3% reduction in RSV-related LRTI hospitalization (95% CI, 67.0%-92.5%).
- Effect was 96.3% (95% CI, 65.5%-99.6%) among infants with congenital heart disease.
- No statistically significant hospitalization reduction among extremely preterm infants alone (65.9%; 95% CI, -10.8% to 89.5%).
- Nationwide matched case-control design using public and private hospital registries post-universal rollout.
Methodological Strengths
- Nationwide registry-based matching across public and private sectors
- Pre-specified subgroup analyses in high-risk categories (CHD, extreme prematurity)
Limitations
- Observational design subject to residual confounding despite matching
- Single-season analysis; durability across seasons and supply constraints not addressed
Future Directions: Multi-season effectiveness, safety monitoring in extremely preterm infants, and comparative implementation studies versus targeted prophylaxis.
IMPORTANCE: Nirsevimab is highly effective in preventing respiratory syncytial virus (RSV) infection in healthy infants. Evidence among infants at higher risk of severe RSV disease, such as those born preterm or with congenital heart disease (CHD), remains limited to clinical settings. OBJECTIVE: To evaluate the association of nirsevimab with the prevention of RSV-related hospitalizations among at-risk infants after implementation of a universal immunization strategy in Chile. DESIGN, SETTING, AND PARTICIPANTS: This case-control study used nationwide health registries of all public and private hospitals in Chile during the 2024 RSV season following the launch of a universal RSV immunization program with nirsevimab. The case group included at-risk infants born preterm (gestational age <36 weeks) or with congenital heart disease (CHD) hospitalized for RSV-related lower respiratory tract infection (LRTI), while the control group included infants not hospitalized for RSV-related LRTI. Each case infant was matched to 4 control infants by age, prematurity or CHD status, and geographic region. EXPOSURE: A single intramuscular dose of nirsevimab administered to all infants born up to 6 months before April 1, 2024, and those born between April 1 and September 30, 2024. MAIN OUTCOME AND MEASURES: The main outcome was RSV-related LRTI hospitalization. Associations were assessed for at-risk infants and high-risk infants (born extremely preterm at gestational age <32 weeks or with CHD), with nirsevimab outcomes associated with RSV-related LRTI hospitalization estimated as (1 - adjusted odds ratio) × 100, with 95% CIs. RESULTS: Of 179 RSV-related LRTI hospitalizations among at-risk infants (including 58 [32.4%] with extreme prematurity, 41 [22.9%] with CHD, and 87 [48.6%] without extreme prematurity and CHD [non-high risk]; categories not mutually exclusive), 177 (median [IQR] age, 210.0 [148.0-266.0] days; 109 male [61.3%]) were successfully matched to 708 control infants (including 55 of 58 [94.8%] with extreme prematurity, 39 of 41 [95.1%] with CHD, and 87 [100%] non-high risk; median [IQR] age, 210.5 [147.8-268.5] days; 393 male [55.5%]). A total of 156 case infants (88.1%) and 689 control infants (97.3%) received nirsevimab. In subgroup analyses, nirsevimab receipt in case vs control infants was 79 of 90 (87.8%) vs 351 of 360 (97.5%) among high-risk infants, 50 of 55 (90.9%) vs 213 of 220 (96.8%) among extremely preterm infants, 33 of 39 (84.6%) vs 153 of 156 (98.1%) among infants with CHD, and 77 of 87 (88.5%) vs 339 of 348 (97.4%) in non-high-risk infants. Nirsevimab was associated with a reduced risk of RSV-related LRTI hospitalization of 84.3% (95% CI, 67.0%-92.5%) among all at-risk infants, 85.1% (95% CI, 60.2%-94.4%) among infants with extreme prematurity and CHD combined, and 96.3% (95% CI, 65.5%-99.6%) among infants with CHD but was not associated with a reduced risk for hospitalization among infants with extreme prematurity alone (65.9%; 95% CI, -10.8% to 89.5%). CONCLUSIONS AND RELEVANCE: This case-control study of Chile's nationwide nirsevimab immunization program found that RSV-related LRTI hospitalizations among infants at higher risk of severe disease were substantially reduced. These findings support replacing targeted palivizumab prophylaxis with a broader, universal nirsevimab strategy as part of RSV prevention policy.