Background National utilization and short-term outcomes of open surgical tracheostomy (OST) versus percutaneous dilatational tracheostomy (PDT) in adults hospitalized for COPD exacerbation are uncertain. Methods Adult hospitalizations not coded as elective, with a primary diagnosis of COPD exacerbation and tracheostomy, in the U.S. National Inpatient Sample (2016-2022) were classified as OST or PDT using ICD-10-PCS approach codes. Utilization trends, in-hospital mortality, length of stay (LOS), and inflation-adjusted charges were compared using survey-weighted multivariable models and inverse probability of treatment weighting (IPTW), with further adjustment for timing, coded severity, and pandemic period. Results Of an estimated 2,970 hospitalizations (594 sampled), 36.5% involved PDT. Annual volumes declined for PDT (215 to 115; P-trend=0.023) and OST (480 to 165; P-trend=0.003). In-hospital mortality was 13.5% (PDT 14.3% vs OST 13.0%; P=0.662). Mortality was higher in 2020-2022 than in 2016-2019 among OST hospitalizations (21.3% vs 10.2%; P=0.006) but not among PDT hospitalizations (18.3% vs 12.7%; P=0.29); annual trends did not differ significantly between approaches (P for interaction=0.061). After adjustment, PDT was not associated with mortality (RR, 1.06; 95% CI, 0.68-1.66), LOS (-0.63 days; 95% CI, -4.19 to 2.94), or charges (ratio, 0.98; 95% CI, 0.85-1.12); estimates were consistent with IPTW, timing and severity adjustment, exclusion of 2020, and within both periods. Conclusions Both OST and PDT volumes declined. No significant association was detected between approach and short-term outcomes, although estimates were imprecise. The mortality increase within OST hospitalizations, concentrated in the pandemic period, warrants cautious interpretation given potential changes in case mix, treatment selection, pandemic-related practice, and unmeasured severity.

Introduction Respiratory muscle impairment is common in patients with severe emphysema, primarily driven by lung hyperinflation. Endobronchial valve (EBV) treatment reduces hyperinflation and may restore respiratory mechanics in this patient population. Our aim was to investigate changes in neural drive and respiratory muscle recruitment following EBV treatment. Methods EBV-eligible emphysema patients from our prior study on diaphragm function were prospectively enrolled (NCT04735731). Respiratory muscle activation and timing were assessed using surface electromyography at baseline and 6 weeks following EBV treatment. Additionally, an age-matched control group without respiratory symptoms was included for comparison. Results We included 25 patients who underwent EBV treatment (mean FEV1 28% predicted, mean RV 233% predicted) and 12 controls. The inspiratory time (Ti) to total time of respiratory cycle (Ttot) ratio (0.35 vs 0.53; p=0.003) was significantly lower in patients compared to controls. Activity of the diaphragm (4.7 vs 0.9 µV; p<0.001) and intercostal muscles (1.2 vs 0.4 µV; p<0.001) during tidal breathing was significantly higher in patients. Furthermore, tonic (end-expiratory) activity of the diaphragm (1.4 vs 0.6 µV; p=0.012) and intercostal muscles (1.4 vs 0.6 µV; p=0.003) was significantly higher as well. Following EBV treatment, all measured outcomes improved significantly, approaching the values observed in the control group. Conclusion These findings indicate that neural drive and respiratory muscle effort are significantly elevated in severe emphysema patients. By reducing lung hyperinflation, endobronchial valve treatment reduces this load, resulting in improved respiratory mechanics and decreased work of breathing, an important contributor to dyspnoea severity.

Emerging respiratory infectious diseases increasingly arise at the human-animal-environment interface and challenge clinicians with rapidly evolving diagnostic, therapeutic, and infection-control decisions. This narrative review summarizes clinically relevant viral and bacterial pathogens that may present as severe respiratory disease, but are easily mistaken for common community-acquired infections during early illness. We focus on zoonotic influenza A viruses, including contemporary H5N1, Middle East respiratory syndrome coronavirus (MERS-CoV), hantaviruses, Nipah virus, and inhalational bacterial threats such as anthrax, pneumonic plague, tularemia, and melioidosis. These infections may progress from non-specific symptoms to severe pneumonia, acute respiratory distress syndrome, shock, neurological complications, disseminated infection, or death. Timely recognition depends on careful assessment of travel, occupational and recreational exposures, animal contact, outbreak signals, and pathogen-specific syndromic clues. Multiplex molecular diagnostics can support early triage and exclusion of common pathogens, but targeted PCR, culture, serology, sequencing, and reference laboratory confirmation remain essential. Management requires prompt supportive care, appropriate isolation, public health notification, and pathogen-directed antimicrobial, antiviral, antitoxin, or prophylactic strategies where available. By integrating clinical presentation, diagnostics, treatment, vaccines, and One Health considerations, this review aims to translate knowledge on emerging infections into practical bedside preparedness.