Health Surveys

RationaleAcute exacerbations of chronic obstructive pulmonary disease (AE-COPD) requiring invasive mechanical ventilation (IMV) are associated with high mortality and long-term disability. Extracorporeal CO₂ removal (ECCO₂R) using modern high-capacity devices may facilitate early endotracheal extubation and reduce IMV-related complications.ObjectivesTo evaluate whether ECCO2R-facilitated early extubation improves clinical outcomes compared with standard IMV in patients with severe AE-COPD requiring IMV.MethodsAdults with acute hypercapnic respiratory failure due to AE-COPD requiring IMV who failed or were ineligible for extubation within 24 hours of intubation were randomized to ECCO2R or no ECCO2R. The primary endpoint was a composite of death or severe disability at day 60.Results18 patients were randomized before the trial was terminated early by the sponsor for financial reasons (planned enrollment: 192). The primary composite endpoint occurred in 0/8 ECCO2R-treated patients versus 3/9 evaluable IMV-treated patients (33%; risk difference -33%; 95% CI -65% to 6%; p = 0.21). IMV duration was shorter in the ECCO2R group (7.1 ± 2.0 vs. 24.3 ± 21.4 days; median 7.0 vs. 16.0 days; mean difference -17.2 days; p = 0.043), yielding, in a post hoc exploratory analysis, more overall device-free days at day 29 (17 ± 4 device-support-free days compared with 8 ± 7 days in the IMV group (p = 0.011)). Ventilator-associated pneumonia occurred in 0 versus 3 patients (37.5%), respectively. Sedation was discontinued earlier in the ECCO₂R group. Severe bleeding occurred in one ECCO₂R-treated patient (12.5%).ConclusionsIn this prematurely terminated trial, ECCO₂R-facilitated early extubation using a device with a capacity to eliminate more than 50% of the average CO2 production, was associated with a shorter duration of invasive mechanical ventilation. Numerical trends favored ECCO2R across several secondary outcomes, although interpretation is limited by premature termination and the very small sample size. Adequately powered multicenter trials are warranted.

BackgroundConventional intracerebral hemorrhage (ICH) functional scores are typically developed based on clinical factors for assessing mortality risk, and their applicability in evaluating functional outcomes in patients with the specific hemorrhagic subtype of mild to moderate ICH(MTM-ICH) remains unclear. Therefore, we aimed to construct a nomogram model to predict early functional dependence in this patient population and to validate three previous general ICH functional scores.MethodsWe conducted a retrospective analysis of data from 575 patients with MTM-ICH (GCS score ≥ 9) treated at our hospital between January 2018 and July 2025. The baseline demographic information, clinical characteristics, and clinical outcomes were collected. Early functional dependence was defined as a modified Rankin Scale (MRS) score ≥ 3 at discharge or 30 days after ICH. Least absolute shrinkage and selection operator (LASSO) and stepwise logistic regression analyses were used to screen for risk factors for early functional dependence and construct a predictive model. The model was visualized using a nomogram, and its predictive performance was compared with three existing ICH functional scores (FUNC, ICH-GS and ICH-FOS). Internal validation of the nomogram was performed using a 10-fold cross-validation combined with bootstrap resampling.ResultsAmong 575 patients with MTM-ICH, 198 (34.4%) developed early functional dependence. LASSO and stepwise logistic regression analyses identified six independent predictors: age, admission GCS score, hematoma volume, thalamic hemorrhage, basal ganglia hemorrhage, and mechanical ventilation. The nomogram based on these factors demonstrated good calibration and superior predictive performance compared to three existing ICH functional scores (AUC = 0.856 for our nomogram, 0.579 for FUNC, 0.601 for ICH-GS, and 0.714 for ICH-FOS, respectively). The decision curve analysis further demonstrated that the model had greater net benefit than the three previous general ICH functional scores. Internal validation confirmed the model's stability and generalizability (10-fold cross-validation mean: 0.846; bootstrap-corrected C-index: 0.844).ConclusionAmong patients with MTM-ICH, advanced age, lower admission GCS score, larger hematoma volume, thalamic or basal ganglia hemorrhage, and mechanical ventilation were associated with a higher risk of early functional dependence. The nomogram developed based on these factors demonstrated high predictive performance. In contrast, conventional ICH functional scores demonstrate certain limitations when assessing this specific hemorrhage subtype.

BackgroundLung cancer imposes a substantial global health burden. Although advances in treatment have improved outcomes, increasingly prolonged and complex care may impose considerable financial pressure on patients and their families. We systematically synthesized evidence on financial toxicity (FT) and its associated factors among patients with lung cancer.MethodsPubMed, Embase, the Cochrane Library, and Scopus were systematically searched through November 2025 for observational studies evaluating FT in patients with lung cancer. Associated factors were synthesized qualitatively and mapped using a harvest plot. Random-effects models were used to pool study-specific FT proportions and mean COST-based scores. Exploratory subgroup analyses were conducted by country income level, disease stage/treatment setting, and COST-based FT threshold. Heterogeneity was assessed using Cochran's Q and I² statistics. Prediction intervals and leave-one-out analyses were used to evaluate variability and robustness.ResultsEighteen studies were included. The pooled proportion of patients meeting study-specific FT definitions across eight studies was 0.55 (95% CI, 0.43-0.66), while the pooled mean COST-based score across ten studies was 22.91 (95% CI, 20.57-25.25). The pooled FT proportion was numerically lower in high-income than in upper-middle-income countries (0.47 vs 0.61; p = 0.171). FT proportions differed by disease stage/treatment setting (advanced/systemic treatment, 0.50; mixed/all-stage populations, 0.67; surgery-dominant populations, 0.42; p = 0.031). No difference was observed between studies using COST-based thresholds of 21-22 and 23-25 (p = 0.999). Lower income, inadequate insurance protection, employment disruption, limited savings, and greater out-of-pocket burden were recurring correlates of worse FT. Substantial heterogeneity persisted across analyses.ConclusionFT represents an important but highly context-dependent burden among patients with lung cancer. Given the substantial heterogeneity and predominantly cross-sectional evidence, the pooled estimates should be interpreted as exploratory summaries rather than universally applicable benchmarks. Standardized longitudinal assessment and prospective evaluation of risk-stratified interventions are warranted.