OBJECTIVES

Epidemiology data on prolonged mechanical ventilation (PMV) and PMV patient features in the Philippines is lacking. This retrospective cross-sectional study aimed to determine the prevalence of PMV among intubated patients, describe patient characteristics and outcomes, and identify risk factors associated with PMV.

A retrospective review of records was done on adult intubated patients admitted under the Medical Intensive Care Unit Service from July 2022 to June 2023. Various clinical characteristics and outcomes of PMV and non-PMV patients were collected, compared, and analyzed. PMV was defined as having MV for ≥6 hours per day
for >21 days.

Among 261 intubated ICU patients admitted, 75 (28.7%) required PMV. PMV patients were older (62 vs.
53.5), had higher Charlson Comorbidity Index scores (4 vs. 3), and required vasopressors (81.33% vs. 54.84%)
and blood products (93.33% vs. 51.08%) more often. Nosocomial infections (86.67% vs. 45.70%), ventila- tor-related (30.67% vs. 12.37%) and in-hospital (66.22% vs. 32.97%) complications developed more frequently.
Outcomes such as ICU length of stay (29.5 vs. 7 days) and hospital mortality (61.33% vs. 41.94%) were longer. Vasopressor use (OR 2.25, 95% CI 1.06-4.76), develop- ment of nosocomial infections (OR 6.20, 95% CI 2.64-
14.56), and development of in-hospital-related compli- cations (OR 2.20, 95% CI 1.13-4.30) were independent predictors of PMV.

In this single-center investigation, 28.7% of ICU patients required PMV. Knowledge of patient characteristics and risk factors aid in the development of interventions that improve outcomes and reduce PMV prevalence. Larger studies are recommended to assess nationwide PMV epidemiology and provide data on the need for step-down units for weaning.

Occupational allergies and respiratory health issues are an increasing concern across various industries, significantly impacting worker productivity, well-being and long-term health outcomes. These health problems are primarily triggered by exposure to airborne allergens such as pollen, mold and chemical irritants commonly found in workplace environments. Climate change exacerbates these issues by altering environmental conditions that influence allergen distribution and intensity. Rising temperatures, increased humidity, worsening air pollution and extreme weather events contribute to prolonged pollen seasons, greater mold proliferation, increased volatile organic compound (VOC) emissions and heightened respiratory health risks among workers. VOCs are chemical pollutants emitted from a range of indoor and outdoor sources, further aggravating air quality in workplace environments.

An emerging concern is the relationship between climate change and thunderstorm asthma, a phenomenon where allergens are dispersed during thunderstorms, leading to acute asthma events. Ongoing research continues to examine how environmental changes contribute to the frequency and intensity of asthma-related health issues, particularly in occupational settings.

Both outdoor and indoor workers face distinct challenges due to climate-driven changes in allergen exposure. Agricultural, forestry and construction workers are especially vulnerable to longer pollen seasons and higher concentrations of air pollutants. In contrast, office, healthcare and industrial workers face increased exposure to indoor allergens due to poor ventilation, rising VOC concentrations and other environmental stressors. Low-income workers, older adults and those in developing countries face disproportionate risks due to limited access to healthcare and protective measures.

This viewpoint article explores the relationship between climate change and occupational respiratory allergies, emphasizing the need for effective workplace adaptation strategies such as improving ventilation systems, using air filtration technology and creating allergen-free zones. It also examines the socioeconomic barriers to implementing these measures, mental health impacts of occupational allergies (including stress, anxiety and absenteeism) and the emergence of new allergens due to changing environmental conditions. Furthermore, technological solutions such as AI-driven air quality monitoring systems and wearable sensors hold promise in mitigating allergen exposure by providing real-time data, enabling proactive health measures and supporting policy development to protect worker health. Addressing these challenges is critical to ensuring workers’ health, well-being and productivity in the face of ongoing climate change.

At present, there is no effective drug treatment for obstructive sleep apnea hypopnea syndrome (OSAHS). It is usually treated by mechanical ventilation through a ventilator. In this paper, a non-invasive bi-level breathing therapy system suitable for home scenarios is developed. The system supports single-level and bi-level positive airway pressure therapies, and introduces the function of inspiratory synchronous trigger based on flow monitoring to enhance the synchrony of patient-ventilator synchronization. The test results show that the performance indicators of the system meet expectations. Each ventilation mode can operate normally and can meet the requirements for the use of home non-invasive ventilators.
Humans ; Sleep Apnea, Obstructive/therapy* ; Equipment Design ; Noninvasive Ventilation/instrumentation* ; Respiration, Artificial

This case report outlines the treatment of an 11-year-old female who underwent adenotonsillectomy six years ago for snoring but experienced postoperative inefficacy. Her symptoms worsened two weeks before readmission, with increased snoring and sleep apnea, disabling her from lying down to sleep. She was readmitted on December 1, 2023, and diagnosed with severe obstructive sleep apnea hypopnea syndrome and hypercapnia. Automatic BiPAP alleviated her symptoms, with sleep breathing parameters normalizing during treatment. Follow-up at one month showed significant acceleration in her growth and resolution of her hypersomnolence issue.
Humans ; Female ; Child ; Hypercapnia/complications* ; Sleep Apnea, Obstructive/complications* ; Positive-Pressure Respiration ; Noninvasive Ventilation

OBJECTIVE: To observe the skin surface temperature at the related back-shu points in the patients with the different levels of pulmonary ventilation function in chronic persistent asthma, and to explore the correlation between the skin temperature at the back-shu points and pulmonary ventilation function indexes based on "lung governing the skin and hair". METHODS: Sixty-one patients with chronic persistent asthma, based on the level of pulmonary ventilation function, were assigned into a reduced pulmonary ventilation function group (reduced function group, 32 cases) and a normal pulmonary ventilation function group (normal function group, 29 cases). In the two groups, the skin surface temperature was measured in the sites of bilateral Feishu (BL13), Geshu (BL17), Pishu (BL20) and Shenshu (BL23); and the pulmonary ventilation function indexes (the percentage of predicted value of forced vital capacity [FVC%pred], the percentage of predicted value of forced expiratory volume in the first second [FEV1%pred], the percentage of predicted value of FEV1/FVC [FEV1/FVC%pred] and the percentage of predicted value of the peak expiratory flow [PEF%pred]) were recorded. The correlation between the skin surface temperature of acupoints and pulmonary ventilation function was analyzed. RESULTS: Compared with the normal function group, the surface skin temperature at the bilateral Feishu (BL13), Geshu (BL17), Pishu (BL20) and Shenshu (BL23) was higher in the reduced function group (P<0.05, P<0.01). Compared with the normal function group, FEV1%pred, FEV1/FVC%pred and PEF%pred were decreased in the reduced function group (P<0.001). There was no significant difference in FVC%pred between the two groups (P>0.05). The skin surface temperature at the bilateral Feishu (BL13), Geshu (BL17), Pishu (BL20) and Shenshu (BL23) was negatively correlated with FVC%pred, FEV1%pred, FEV1/FVC%pred and PEF%pred in 61 patients with chronic persistent asthma (P<0.001, P<0.01, P<0.05). CONCLUSION The skin surface temperature at back-shu points is elevated in line with the the decline of pulmonary ventilation function in the patients with chronic persistent asthma, presenting a negative correlation with pulmonary ventilation function indexes. It is preliminarily verified that back-shu point is characterized by reflecting the visceral disorders.
Humans ; Female ; Male ; Asthma/therapy* ; Middle Aged ; Adult ; Skin Temperature ; Lung/physiopathology* ; Acupuncture Points ; Pulmonary Ventilation ; Aged ; Chronic Disease/therapy* ; Young Adult ; Hair

Real-time acquisition of pulmonary ventilation and perfusion information through thoracic electrical impedance tomography (EIT) holds significant clinical value. This study proposes a novel method based on the rime (RIME) algorithm-optimized variational mode decomposition (VMD) to separate lung ventilation and perfusion signals directly from raw voltage data prior to EIT image reconstruction, enabling independent imaging of both parameters. To validate this approach, EIT data were collected from 16 healthy volunteers under normal breathing and inspiratory breath-holding conditions. The RIME algorithm was employed to optimize VMD parameters by minimizing envelope entropy as the fitness function. The optimized VMD was then applied to separate raw data across all measurement channels in EIT, with spectral analysis identifying relevant components to reconstruct ventilation and perfusion signals. Results demonstrated that the structural similarity index (SSIM) between perfusion images derived from normal breathing and breath-holding states averaged approximately 84% across all 16 subjects, significantly outperforming traditional frequency-domain filtering methods in perfusion imaging accuracy. This method offers a promising technical advancement for real-time monitoring of pulmonary ventilation and perfusion, holding significant value for advancing the clinical application of EIT in the diagnosis and treatment of respiratory diseases.
Humans ; Electric Impedance ; Algorithms ; Tomography/methods* ; Pulmonary Ventilation/physiology* ; Lung/diagnostic imaging* ; Image Processing, Computer-Assisted/methods* ; Adult

Lung cancer is the leading cause of cancer-related deaths worldwide. Radiation pneumonitis is a major complication in lung cancer radiotherapy. Four-dimensional computed tomography (4DCT) imaging provides dynamic ventilation information, which is valuable for lung function assessment and radiation pneumonitis prevention. Many methods have been developed to calculate lung ventilation from 4DCT, but a systematic comparison is lacking. Prediction of radiation pneumonitis using 4DCT-based ventilation is still in an early stage, and no comprehensive review exists. This paper presented the first systematic comparison of functional lung ventilation algorithms based on 4DCT over the past 15 years, highlighting their clinical value and limitations. It then reviewed multimodal approaches combining 4DCT ventilation imaging, dose metrics, and clinical data for radiation pneumonitis prediction. Finally, it summarized current research and future directions of 4DCT in lung cancer radiotherapy, offering insights for clinical practice and further studies.
Humans ; Lung Neoplasms/diagnostic imaging* ; Four-Dimensional Computed Tomography/methods* ; Radiation Pneumonitis/etiology* ; Algorithms ; Lung/radiation effects* ; Pulmonary Ventilation

OBJECTIVES: To investigate the efficacy of volume-guaranteed high-frequency oscillatory ventilation (HFOV-VG) in preterm infants with respiratory distress syndrome (RDS) and its impact on blood flow in the middle cerebral artery (MCA). METHODS: A prospective study was conducted on 120 preterm infants with RDS who were admitted to the Department of Neonatology at Qinhuangdao Maternal and Child Health Hospital from March 2020 to December 2023. According to the mode of ventilation, the infants were divided into two groups: a conventional mechanical ventilation (CMV) group (60 infants) and an HFOV-VG group (60 infants). The two groups were compared in terms of baseline data, MCA hemodynamic parameters, complications, and outcomes. RESULTS: Compared with the CMV group, the HFOV-VG group had significantly shorter durations of mechanical ventilation and hospital stay and a significantly higher overall response rate (P<0.05). The HFOV-VG group demonstrated significantly better peak systolic velocity, end-diastolic velocity, and mean flow velocity (P<0.05). The HFOV-VG group also exhibited significantly lower 28-day mortality rates and lower incidence rates of bronchopulmonary dysplasia and intraventricular hemorrhage than the CMV group (P<0.05). CONCLUSIONS HFOV-VG can effectively improve cerebral blood perfusion, reduce cerebrovascular resistance, shorten the durations of mechanical ventilation and hospital stay, and enhance overall treatment efficacy. It has significant advantages in reducing the risk of 28-day mortality, bronchopulmonary dysplasia, and intraventricular hemorrhage in preterm infants with RDS.
Humans ; High-Frequency Ventilation/adverse effects* ; Infant, Newborn ; Respiratory Distress Syndrome, Newborn/physiopathology* ; Female ; Middle Cerebral Artery/physiology* ; Male ; Prospective Studies ; Cerebrovascular Circulation ; Infant, Premature

BACKGROUND AND OBJECTIVES

A mounting evidence links dysregulated immune response to cases of fatal pneumonia seen in COVID-19 infection. We aimed to validate the COVID-19-associated Hyperinflammatory Syndrome (cHIS) score, a novel clinical tool devised to identify those at risk for adverse outcomes, in a local population and investigate the relationship of cHIS score taken at admission and the risk of mortality and the need of mechanical ventilation.

This retrospective cohort study analyzed the sociodemographic, clinical, and laboratory data of 1,881 COVID-19 patients admitted at a tertiary hospital in Davao City, Philippines from January to December 2021. We calculated the cHIS score, composed of six clinical and laboratory criteria from admission, and used multivariate logistic regression to determine the risk of mortality and need of mechanical ventilation.

The cHIS score taken at admission, regardless of cut-off value, was a significant predictor of mortality (OR 0.979 [99% CI 0.894-1.064]) and need of mechanical ventilation (OR 0.586 [99% CI 0.4975-0.6745]). Using the Youden Index, a cut-off cHIS score of 3 or more was a better predictor of mortality (sensitivity, 88.59%; specificity, 71.72%), and a cut-off score of 2 or more was a better predictor of need of mechanical ventilation (sensitivity, 84.02%; specificity, 70.82%) than other cutoff cHIS scores.

Among COVID-19 patients, the cHIS score at admission correlated with the risk of mortality and the need of mechanical ventilation. Cutoff scores of 3 and 2 had the optimal sensitivities and specificities to predict the risk of mortality and the need of mechanical ventilation, respectively.

Objective:Retrospective analysis of clinical data of 123 patients with atticotomy, exploring the clinical characteristics of patients undergoing atticotomy and the efficacy of hearing reconstruction methods. Methods:123 patients with atticotomy were divided into three groups according to the ossicular chain treatment method: preservation of the ossicular chain group（37 cases）, cartilage elevation of stapes group（49 cases）, and PORP group（37 cases）. The clinical characteristics of patients with atticotomy, preoperative and postoperative hearing levels of the three groups of patients, and postoperative complications were analyzed. Results:①89.43%（110/123） of patients who underwent atticotomy were pars flaccida cholesteatomas, while 10.57%（13/123） of patients were secondary cholesteatoma, adhesive otitis media, pars tensa cholesteatomas, congenital cholesteatoma, and external auditory canal cholesteatoma; ②The group with preserved ossicular chain had a shorter medical history compared to the other two groups, and the difference was statistically significant（P<0.001）. The group with preserved ossicular chain had smaller inter group ABG values and average ABG values at frequencies of 500 Hz, 1 000 Hz, 2 000 Hz and 4 000 Hz before surgery compared to the other two groups, and the difference was statistically significant（P<0.001）; The differences in ABG frequencies and average ABG between the three groups of patients before and after surgery were statistically significant（P<0.05）; Postoperative ABG: The group preserving the ossicular chain had a smaller difference compared to the other two groups, with a statistically significant difference（P<0.05）. There was no statistically significant difference between the cartilage plus high stapes group and the PORP group（P>0.05）; ③At 3 months post surgery, all patients achieved ear dryness. Two patients experienced delayed facial paralysis after conservative treatment, and all recovered. One patient had a slight decrease in bone conductivity due to the influence of grinding during hammer anvil fixation surgery, and one patient experienced a recurrence after 4 years due to residual surgery. 81 patients（65.85%） experienced non cartilage repair area invagination during postoperative follow-up, of which 5 patients（4.07%, 5/123） underwent a second surgery. Although the rest of the patients had local invagination, they could still self clean and did not form a cholesteatoma. The total recurrence rate was 4.88%（6/123）, with an average recurrence time of 4 years. Conclusion:Atticotomy surgery is most commonly used for pars flaccida cholesteatomas with limited scope. The incidence of postoperative retraction is high, and regular follow-up is necessary; When conditions permit during surgery, priority can be given to preserving the ossicular chain for better postoperative hearing. Both cartilage elevation of stapes and PORP implantation can effectively improve hearing, and there is no difference in postoperative hearing between the two methods. However, there is a risk of detachment and high cost after PORP surgery, and cartilage elevation of stapes is limited by insufficient height and stapes head erosion. Therefore, it is necessary to choose a comprehensive hearing reconstruction method based on the patient's condition.
Humans ; Retrospective Studies ; Female ; Male ; Adult ; Middle Aged ; Plastic Surgery Procedures/methods* ; Hearing ; Middle Ear Ventilation/methods* ; Treatment Outcome ; Adolescent ; Child ; Ossicular Replacement/methods* ; Ear Ossicles/surgery* ; Young Adult ; Tympanoplasty/methods*