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Daniela Gompelmann,1,2,* Hyun-ju Lim,3,4,* Ralf Eberhardt,1,2 Vasiliki Gerovasili,5 Felix JF Herth,1,2 Claus Peter Heussel,2–4 Monika Eichinger3,4 1Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, 2Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, 3Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, 4Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany; 5First Critical Care Department, National and Kapodistrian University of Athens, Athens, Greece *These authors contributed equally to this work Background: Endoscopic valve implantation is an effective treatment for patients with advanced emphysema. Despite the minimally invasive procedure, valve placement is associated with risks, the most common of which is pneumothorax. This study was designed to identify predictors of pneumothorax following endoscopic valve implantation. Methods: Preinterventional clinical measures (vital capacity, forced expiratory volume in 1 second, residual volume, total lung capacity, 6-minute walk test), qualitative computed tomography (CT) parameters (fissure integrity, blebs/bulla, subpleural nodules, pleural adhesions, partial atelectasis, fibrotic bands, emphysema type) and quantitative CT parameters (volume and low attenuation volume of the target lobe and the ipsilateral untreated lobe, target air trapping, ipsilateral lobe volume/hemithorax volume, collapsibility of the target lobe and the ipsilateral untreated lobe) were retrospectively evaluated in patients who underwent endoscopic valve placement (n=129). Regression analysis was performed to compare those who developed pneumothorax following valve therapy (n=46) with those who developed target lobe volume reduction without pneumothorax (n=83). Finding: Low attenuation volume% of ipsilateral untreated lobe (odds ratio [OR] =1.08, P=0.001), ipsilateral untreated lobe volume/hemithorax volume (OR =0.93, P=0.017), emphysema type (OR =0.26, P=0.018), pleural adhesions (OR =0.33, P=0.012) and residual volume (OR =1.58, P=0.012) were found to be significant predictors of pneumothorax. Fissure integrity (OR =1.16, P=0.075) and 6-minute walk test (OR =1.05, P=0.077) were also indicative of pneumothorax. The model including the aforementioned parameters predicted whether a patient would experience a pneumothorax 84% of the time (area under the curve =0.84). Interpretation: Clinical and CT parameters provide a promising tool to effectively identify patients at high risk of pneumothorax following endoscopic valve therapy. Keywords: endoscopic lung volume reduction, COPD, emphysema, pneumothorax, valve therapy

Background Age is a critical factor for the assessment of patients attended by emergency medical services (EMSs). However, how age modifies early warning scores' (EWSs) predictive ability should be unveiled. Aim To determine how age influences the performance of EWS [National Early Warning Score 2 (NEWS2), VitalPAC-Early Warning Score (ViEWS), Rapid Acute Physiology Score (RAPS) and modified Rapid Emergency Medicine Score (mREMS)] to predict 2-day mortality. The secondary objective was to determine the performance of EWSs at different age ranges. Design A prospective, observational study performed between November 2019 and July 2023. Methods A multicenter, ambulance-based study, considering 38 basic life support units and six advanced life support units referring to four tertiary care hospitals. Eligible patients were adults recruited from among all phone requests for emergency assistance who were later evacuated to emergency departments. The primary outcome was 2-day in-hospital mortality (includes all-cause mortality). The main measures were demographical and vital signs needed for EWS calculation. Results and discussion A total of 8028 participants fulfilled the inclusion criteria, with 7654 survivors and 374 non-survivors. Among age ranges, the 2-day mortality was 2.8% for the ≤44 years, 3.3% for the 45–64 years, 4.1% for the 65–74 years and 6.7% for the ≥75-year age group. The inclusion of age significantly improved the Area Under the Curve (AUC) in all the scores (P  = 0.006 for non-age-adjusted mREMS, P  = 0.001 for NEWS2, P  = 0.002 for ViEWS, P  = 0.028 for RAPS, all compared with their counterparts with age). Conclusion Our results demonstrated that the incorporation of age into the EWS improved the performance of the scores. These results will allow the EMS to improve patient management and resource optimization by including an easy-to-obtain variable. [ABSTRACT FROM AUTHOR]

This article discusses a study that used real-time magnetic resonance imaging (MRI) to investigate the influence of breathing on cardiac function in pediatric patients with chronic right ventricular (RV) volume overload due to congenital heart disease (CHD). The study included six CHD patients and six healthy controls, and the results showed that RV end-diastolic volume and RV stroke volume increased during inspiration in both groups, but the increase in RV ejection fraction was significantly lower in the CHD patients. Additionally, the study found that the Frank-Starling relationship of the RV was impaired in the CHD patients. The authors conclude that real-time MRI combined with respiratory-based binning can provide a noninvasive and dynamic parameter of right ventricular function in pediatric CHD patients with chronic RV volume overload. [Extracted from the article]