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To quantify the overall diagnostic accuracy of the Mayo model in predicting the probability of malignancy of solitary pulmonary nodules (SPNs) by carrying out a systematic review and meta-analysis.PubMed, Scopus, and references of relevant articles were searched systematically from inception up to 21 September 2021, to identify observational cohort studies, which reported on the diagnostic accuracy of the Mayo model in predicting the probability of malignancy in SPNs. The primary outcome was the pooled area under the receiver operating characteristic (ROC) curve (AUC). Secondary outcomes were sensitivity, specificity, and diagnostic odds ratio (DOR). The meta-analysis was registered with PROSPERO.Forty studies involving 46,694 patients were included. The overall pooled AUC was 0.730 (95% confidence interval [CI]: 0.704-0.755), while sensitivity and specificity were 0.78 (95% CI: 0.67-0.86) and 0.68 (95% CI: 0.57-0.77), respectively. Subgroup analyses revealed that the model had a better performance among datasets with increased prevalence of current/ex-smokers (AUC 0.762, 95% CI: 0.713-0.810, versus AUC 0.695, 95% CI: 0.660-0.730 and among studies conducted in continents other than Asia (AUC 0.769, 95% CI: 0.732-0.806 versus AUC 0.699, 95% CI: 0.669-0.729, p0.001, I2=91.20%) CONCLUSIONS: The Mayo model seems a fair diagnostic tool; however, the synthesised evidence informs clinicians and researchers that it may be more applicable on certain patient populations, such as smokers and non-Asians.

BackgroundNoninvasive ventilation (NIV) is considered as the first-line treatment for acute exacerbation of COPD (AECOPD) complicated by respiratory acidosis. Recent studies demonstrate a role of nasal high-flow oxygen (NHF) in AECOPD as an alternative treatment in patients intolerant to NIV or with contraindications to it.AimThe study aimed to evaluate whether NHF respiratory support is noninferior compared to NIV in respect to treatment failure, defined as need for intubation or change to alternative treatment group, in patients with AECOPD and mild-to-moderate acute or acute-on-chronic hypercapnic respiratory failure.MethodsWe designed a multicentre, prospective, randomised trial on patients with AECOPD, who have pH7.25 and PaCO2 >45 mmHg, in whom NIV is indicated as a first-line treatment. According to power analysis, 498 participants will be required for establishing noninferiority of NHF compared to NIV. Patients will be randomly assigned to receive NIV or NHF. Treatment will be adjusted to maintain SpO2 between 88%–92% for both groups. Arterial blood gases, respiratory variables, comfort, dyspnoea score and any pulmonary or extrapulmonary complications will be assessed at baseline, before treatment initiation, and at 1, 2, 4, 6, 12, 24, 48 h, then once daily from day 3 to patient discharge, intubation or death.ConclusionGiven the increasing number of studies demonstrating the physiological effects of NHF in COPD patients, we hypothesise that NHF respiratory support will be noninferior to NIV in patients with AECOPD and mild-to-moderate acute or acute on chronic hypercapnic respiratory failure.

Introduction: Non-invasive ventilation (NIV) use in chronic obstructive pulmonary disease (COPD) exacerbation has increased significantly, however, approximately 1/3 of patients have either contraindications or cannot tolerate NIV therapy. Recently, nasal high flow (NHF) oxygen therapy has been introduced for the management of hypoxemic respiratory failure with positive physiological effects on respiratory support. These effects have also been observed in stable COPD patients with or without chronic hypercapnia. However, the use of NHF during acute COPD exacerbations (AECOPD) is still questionable with limited studies showing favourable outcomes. Objective: To evaluate NHF compared to NIV in patients with AECOPD and acute or acute on chronic hypercapnic respiratory failure. Method: A randomized controlled trial (RCT) in patients presenting with AECOPD (defined by pH >7.25 45mmHg) and are clinically indicated for NIV therapy (pH 45mmHg, RR>23). Primary end point is treatment failure, secondary end points include, changes in respiratory variables, patient comfort and presence of pulmonary and extra-pulmonary complications. Results: So far, 27/498 participants have been enrolled. Mean age 74 (+/- 16) years. Seventy-eight percent were male. Prior to randomisation 9/27 (33.3%) had a pH between 7.30-7.35 and 18/27 (66.6%) had a pH between 7.25-7.29. Twelve patients (44%) were randomised to NIV and 15 (56%) to NHF. To date, treatment failure in the NIV cohort is 16% and 27% in the NHF cohort. Conclusions: These are preliminary data of a large RCT. Further and more detailed analysis will be presented at the Congress.