Compared with obstructive sleep apnea, the incidence of central sleep apnea (CSA) is lower, but its causes are numerous, and the incidence varies greatly depending on the underlying factor. Clinically, the most common cause of CSA is heart failure. In 2025, the American Academy of Sleep Medicine published a clinical practice guideline for the treatment of CSA in adults, which provides important updates to previous recommendations, especially regarding the treatment of heart failure-related CSA. The updates cover various treatment options, including continuous positive airway pressure, adaptive servo-ventilation, low-flow oxygen therapy, acetazolamide, and transvenous phrenic nerve stimulation. The new guideline emphasizes that treatment should be individualized based on the etiology, clinical characteristics, coexisting diseases, and polysomnography findings of each patient. It also highlights the importance of outcome measures such as quality of life, patient-reported outcomes, and hypoxic burden. This article interprets the main recommendations of the guideline, introduces some important research background, and raises several considerations based on clinical practice.

A Retrospective Study of the Respiratory Rate Oxygenation and Respiratory Rate Oxygenation-Heart Rate Indexes in Predicting the Results of Conventional Oxygen Therapy in Patients with Acute Respiratory Failure.

Methaemoglobin (MetHb) is an oxidised form of haemoglobin (Hb) unable to bind oxygen. Raised levels of MetHb reduce the blood's oxygen-carrying capacity, causing potentially severe hypoxaemia and possible death. The condition arises from three main pathologies: mutations in globin genes causing Haemoglobin-M, inherited deficiency of the enzyme cytochrome b5 reductase (CytB5R) responsible for reducing MetHb back into functional Hb, and exposure to some oxidising agents. Well-documented causative agents include dapsone and cocaine-derived anaesthetics, with emerging evidence highlighting an increasing contribution from recreational and non-prescribed exposures. As the concentration of MetHb level increases, the oxygen-carrying capacity of the blood decreases. MetHb levels are usually measured by co-oximetry. Patients are typically asymptomatic at MetHb concentrations <10% with symptoms developing as levels increase, including cyanosis, confusion, arrhythmias, coma and death. These features will present alongside misleadingly normal partial pressure of oxygen in arterial blood and arterial oxygen saturation values on arterial blood gas and will not improve with supplemental oxygen. Management depends on severity, with intravenous methylene blue remaining first-line treatment for symptomatic cases. Alternative therapies include high-dose vitamin C, exchange transfusion and potentially hyperbaric oxygen, although there is little evidence to suggest how these should be used. Due to the potentially confusing acute presentation of the condition, the diagnosis can easily be missed.

Effect of CPAP or oxygen on high loop gain sleep apnea and associated blood pressure change- an analysis using respiratory self-similarity.

In this case, we describe the remote telehealth leadership of emergent tube thoracostomy in a patient with a critical respiratory status. The patient had presented to a small rural health care facility with breathlessness and hypoxia despite supplemental oxygen. A subsequent chest x-ray revealed a large pneumothorax requiring emergent treatment to prevent respiratory demise. Due to their location, the arrival of a critical care team would be delayed, and the local staff had very limited prior experience with chest procedures. Through remote telehealth leadership, the local team was guided through initial attempts at the Seldinger tube thoracostomy technique, before progressing to an open approach following failure of the initial attempt. Ultimately, the patient was stabilised and remained admitted locally, avoiding aeromedical retrieval. Key learnings included the need to develop a shared mental model of the procedure, responding to local equipment limitations, the leadership response to initial technique failure, and maintenance of situational awareness. This furthers evidence provided in prior case reports that high acuity low occurrence critical care procedures can be facilitated via remote telehealth support.

Innovative wound management of refractory venous ulcers with topical oxygen therapy.

Sepsis is a clinical syndrome marked by a dysregulated host response to infection, impairing oxygen delivery and utilization and causing organ dysfunction. Hypoxemia, which can cause significant tissue and organ damage, commonly occurs in sepsis. Thus, oxygen therapy is essential in patients with sepsis. However, the optimal oxygenation target for these patients remains controversial. To evaluate the effects of different oxygenation targets on short- and medium-term outcomes in patients with sepsis. A prospective, single-center, randomized controlled trial was conducted. The primary outcome was 28-day mortality. Secondary outcomes included 90-day mortality and intergroup comparisons of mechanical ventilation and vasopressor use during hospitalization. In total, 270 patients were randomly assigned to the conservative oxygenation, conventional oxygenation, and hyperoxygenation target groups (n = 86, 93, and 91), of whom 35 (40.7%), 32 (34.4%), and 17 (18.7%) died by day 28, respectively. The 28-day mortality significantly differed between these groups ( P = 0.005). Pairwise comparison revealed a significant difference between the conservative oxygenation and hyperoxygenation target groups (χ 2 = 10.132, P = 0.001). Kaplan-Meier analysis showed significant differences in survival distributions among the groups (χ 2 = 10.340, P = 0.006). The 90-day mortality rates were 50.0%, 41.9%, and 36.3% in the conservative oxygenation, conventional oxygenation, and hyperoxygenation target groups, respectively, exhibiting no significant difference. Compared with conservative oxygen therapy, hyperoxygenation (PaO 2 : 100-150 mmHg) reduced 28-day mortality in patients with sepsis. However, no significant differences were observed among oxygenation targets regarding 90-day outcomes.

This study evaluated the impact of Multimodal Neurologic Enhancement (MNE), a music therapy intervention, on clinical outcomes of preterm infants (< 34weeks; N=106) and a subgroup of extremely preterm infants (< 28weeks; n=20). A randomized trial was utilized, where infants were randomized to receive MNE or standard of care and matched based on gestational age at birth, sex, and neurologic injury. Infants in the MNE group received eight, 20-minute MNE sessions, beginning at 32weeks post menstrual age (PMA). Analysis included negative binomial and linear regression, adjusting for relative covariates. Across the full cohort and the extremely preterm subgroup, there were no significant differences in PMA at discharge, duration of oxygen therapy (days), PMA at transition off oxygen therapy, or transition to full oral feeding (days). Among the extremely preterm subgroup, MNE was associated with a significantly shorter length of stay (days) (IRR=0.81, corresponding to β̂=-0.21; 95% CI for IRR: 0.68, 0.98). These findings suggest that MNE may offer targeted benefits for extremely preterm infants. This study highlights the potential of MNE as a safe, feasible intervention to support clinical outcomes during Neonatal Intensive Care Unit admission for preterm infants.

Emergency Assessment and Treatment of Respiratory Disease.

Pulmonary Hypertension.

Acute chest syndrome (ACS) is a severe complication of sickle cell disease (SCD) associated with significant morbidity and mortality, necessitating optimized prevention and management strategies for improved patient outcomes. This review does not evaluate red blood cell exchange, as no randomized controlled trials meeting our inclusion criteria reported outcomes for this intervention. A thorough literature review identified interventions for ACS in SCD patients. Seventeen randomized controlled trials (RCTs) underwent assessment using the Cochrane Risk of Bias 2 tool, and a frequentist network meta-analysis was conducted to compare interventions. The use of hydroxyurea and simple transfusion was associated with a lower proportion of patients who developed ACS during the study period compared with standard care (RR: 0.42, 95% CI [0.20-0.86]; RR: 0.31, 95% CI [0.12-0.75], respectively). Intravenous dexamethasone was associated with a lower risk of persistent fever, reduced need for blood transfusion, and shorter durations of both opioid and oxygen therapy, as well as a shorter in-hospital stay (p < 0.01 for all comparisons). When compared with standard care, hydroxyurea was associated with reduced requirement for blood transfusion (RR: 0.17, 95% CI [0.04, 0.73]), with a similar association observed for intravenous dexamethasone (RR: 0.19, 95% CI [0.05, 0.77]). No significant associations were identified between any treatment and rates of hospitalization or readmission. This study offers insights into ACS treatment efficacy and safety in SCD patients. Hydroxyurea and transfusion strategies demonstrated the strongest evidence for reducing acute chest syndrome risk. Corticosteroids were associated with improved inpatient outcomes in predominantly pediatric populations, but concerns regarding potential rebound pain and rehospitalization warrant cautious interpretation. Larger trials are required before routine steroid use can be broadly recommended.

Tumor disaggregation sensitizes radio-therapy for low rectal tumor.

Human infection with Andes hantavirus: an update for the general physician.

Residual Pulmonary Hypertension and the Need for Home Supplemental Oxygen After Pulmonary Endarterectomy: A Nine-Year Cohort Study

Methods used in assessing decannulation timing after head and neck reconstruction vary widely. In this study, we examined the effect of implementation of a standardized post-operative tracheostomy decannulation protocol on our primary endpoint, return to the emergency room within 30 days for upper airway related issues, as well as on decannulation rates. We also examined the association between several patient/intervention characteristics and successful decannulation prior to discharge. Data were collected prospectively for all patients who underwent free flap reconstruction requiring tracheostomy between September 2020 and October 2021 at a single tertiary center. A standardized protocol was implemented to determine candidacy for decannulation prior to discharge. Our protocol was two tiered with initial criteria including: tolerance of finger occlusion, passing of abbreviated fiberoptic evaluation of swallowing (FEES), requiring suction no more frequently than every 4 h, adequate cough, no supplemental oxygen requirements, and alert mental status. Patients meeting these criteria progressed to a 24-h capping trial. Our cohort consisted of 114 patients who underwent the decannulation protocol, as well as a retrospective control cohort of 96 patients from prior to protocol implementation for a total of 230 patients. Although not significant (p = 0.34), a higher proportion of our protocol cohort, 45/114 (39.5%) of patients decannulated before discharge versus 31/96 (32.3%) of our control patients. For our primary endpoint, only a single patient in the protocol cohort had a return to the ED within 30 days for upper airway related issues compared with 6 patients in the control cohort (0.9% vs. 6.2%; p = 0.048), and we found no significant difference in readmission rates. We also found that across both cohorts, patients with an anterior defect involving the genial tubercle had lower rates of decannulation vs. other patients (24.3% vs. 42.1%; p = 0.017). Implementation of a standardized protocol for post-operative head and neck reconstruction patients can give providers greater confidence in discerning which patients are appropriate for decannulation prior to discharge and prevent returns to the emergency room.

Sepsis is a leading cause of preventable death in low-resource settings, where delays in recognition and emergency department (ED) treatment are common. Limited access to training also contributes to poor outcomes. We hypothesized that a contextualized telesimulation and debriefing program would be associated with better sepsis-related outcomes and time-critical care processes in children presenting to our center in Kumasi, Ghana. We also determined the program's acceptability and feasibility in our clinical providers. We conducted a 12-month mixed-method quasi-experimental (before vs. after implementation) study at Komfo Anokye Teaching Hospital, 2023-2024. Pediatric ED providers completed 30-minute, low-bandwidth telesimulation sessions using culturally-adapted real patient videos, filmed in the local Ghanaian hospital. Clinical outcomes and care processes were evaluated pre- and post-intervention. Trained observers recorded time-critical interventions: shock recognition, oxygen use, IV access, fluid bolus, reassessment, blood cultures, and antibiotics. Acceptability and feasibility were assessed using validated surveys. Tertiary academic hospital with 1200 beds, including 15 pediatric ED beds and 4 PICU beds. ED healthcare providers as well as clinical data from patients 2 months to 14 years old, screened at triage for suspected sepsis or septic shock. None. Post- vs pre-implementation care periods had mortality of 7 of 67 (10%) vs. 25 of 70 (36%), which represents an associated decrease in odds ratio (OR) of death 0.2 (95% CI, 0.1-0.5; p = 0.001). The post- vs pre-implementation changes in care characteristics, included: greater odds of supplemental oxygen use (OR 2.4 [95% CI, 1.0-5.7] p = 0.044) and IV placement (OR 3.8 [95% CI, 1.3-13.1] p = 0.012). Also, among trainees, 44/45 agreed that the program was acceptable and feasible. In our 2023-2024 pre- vs. post-implementation study, we found that contextualized telesimulation and debriefing were associated with lower odds of mortality, improved characteristics of care, and were acceptable and feasible to the healthcare team.

The incidence of postoperative pulmonary complications (PPCs3) following abdominal surgery varies across surgical specialties. It remains unclear to what extent the incidence of PPCs is attributable to known patient-related factors and anaesthesia duration, rather than to differences inherent to the surgical specialty itself. Post-hoc analysis of an observational study describing postoperative outcomes in patients undergoing urological, gastrointestinal, and gynaecological abdominal surgery. The primary endpoint was a composite measure of PPCs. Secondary endpoints included the individual incidence of each PPC. Propensity score weighting was used to create a cohort with similar patient characteristics and anaesthesia duration. The cohort consisted of 3306 patients across 146 centres in 29 countries-367 underwent urological surgery, 2100 underwent gastrointestinal surgery, and 839 underwent gynaecological surgery. Risk scores for PPCs were highest in urological surgical patients, followed by gastrointestinal and gynaecological surgical patients. PPCs also occurred most often after urological surgery (17.7%), followed by gastrointestinal (14.9%) and gynaecological surgery (9.8%) (p < 0.001). After weighting, these differences in incidence disappeared, with comparable rates across the three groups (urological surgery 15.7%, gastrointestinal 14.5%, gynaecological 12.2%; p = 0.340). Apart from unplanned supplementary oxygen, all PPCs were most frequent after gastrointestinal surgery and least common following gynaecological surgery. In this worldwide cohort of patients undergoing abdominal surgery, the incidence of PPCs varied across urological, gastrointestinal, and gynaecological surgery; the differences in incidence may be more strongly influenced by patient-related factors and anaesthesia duration than by the characteristics of the surgical specialty itself. Gastrointestinal surgeries showed the highest rates of severe PPCs.

Hyperbaric Oxygen Therapy - a Potential Therapy for Macro- and Trace Elements' Imbalance in Patients with Chronic Kidney Disease?

Hyperbaric oxygen therapy for fatigue recovery: Experimental evidence and optimal regimen from a mouse model established by a chronic multi-stressor paradigm.

Hypoxemia is a frequent complication during bronchoscopy, and optimal oxygenation strategies remain clinically important. Previous evidence suggests that high-flow nasal cannula (HFNC) may outperform conventional oxygen therapy (COT). A meta-analysis of randomized controlled trials (RCTs) was conducted by searching PubMed, Embase, and Cochrane databases for studies comparing HFNC with COT in adult patients undergoing flexible bronchoscopy. Outcomes included the incidence of hypoxemia, lowest SpO2, procedure duration, patient comfort, and sedation dose. Pooled data were analyzed using a random-effects model, with results reported as risk ratios (RR), mean differences (MD), or standardized mean differences (SMD), as appropriate. Heterogeneity was assessed using the Cochran Q test and I2 statistic. Fourteen RCTs (n=2480) were included: 1263 patients (50.9%) received HFNC. HFNC significantly reduced the risk of hypoxemia (RR, 0.41; 95% CI: 0.29-0.59; P<0.0001) and increased minimum SpO2 (MD, +5.10 percentage points; 95% CI: 3.30-6.91; P<0.0001). There was no significant difference in patient comfort (SMD, -0.07; 95% CI: -0.25 to 0.11; P=0.46) and procedure time (MD, -0.73min; 95% CI: -1.73 to 0.27; P=0.154). Sedation requirements were slightly higher in the HFNC group (SMD, 0.17; 95% CI: 0.04-0.29; P=0.008). HFNC significantly reduces hypoxemic events and improves oxygenation compared with COT during bronchoscopy. Although anesthetic use slightly increased, there was no difference in procedure time or patient comfort.