Aayushi Pareek

Background: High-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) are both recommended first-line strategies for acute hypoxemic respiratory failure (AHRF), but the optimal choice remains debated. Prior meta-analyses have been limited by heterogeneous populations and incomplete publication bias assessment.Methods: MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov, and WHO ICTRP were searched to November 2025 (PROSPERO: CRD420261299607; PRISMA 2020). Adults (≥18 years) with de novo AHRF (PaO₂/FiO₂ <300 mmHg) were eligible; COPD with respiratory acidosis and acute cardiogenic pulmonary edema were excluded. Three eligible RENOVATE 2024 subgroups were pre-specified for the composite endpoint only. Risk ratios (RR) were pooled using DerSimonian–Laird random-effects with 95% prediction intervals (PI). Publication bias was assessed by Egger's test and trim-and-fill. Four sensitivity analyses, subgroup analyses, and meta-regression were performed.Results: Twelve studies (6 RCTs, 6 observational; 2015–2026; n=3,525) were included. HFNC significantly reduced intubation versus NIV (k=10; RR 0.80, 95% CI 0.65–0.98; p=0.028; I²=36.6%; 95% PI [0.52–1.22]). Mortality did not differ (k=9; RR 0.88, 95% CI 0.66–1.17; p=0.391). Composite treatment failure trended toward HFNC (k=11; RR 0.85, 95% CI 0.71–1.02; p=0.074). Trim-and-fill strengthened the intubation finding (adjusted RR 0.71, 95% CI 0.57–0.88). All four sensitivity analyses were concordant (range RR 0.76–0.84). No subgroup interaction or meta-regression moderator was significant.Conclusions: HFNC significantly reduces intubation versus NIV in adults with de novo AHRF with equivalent mortality, robust to all sensitivity analyses and convergent with SOHO 2026. The prediction interval [0.52–1.22] indicates patient and institutional factors modulate benefit; intubation must not be delayed in objective clinical deterioration.

Background: Surgical trauma disrupts hormone networks, but the duration required for these systems to recover remains unclear. We hypothesize that significant perioperative stress would trigger protracted abnormalities of the thyroid axis extending past 28 days. Methods: This retrospective exploratory study analyzed opportunistically obtained thyroid-related laboratory values (free T3 [FT3], free T4 [FT4], and thyroid-stimulating hormone [TSH]) and serum albumin from electronic medical records of patients undergoing CABG, AVR, or PCI between 2017 and 2022. Preprocedural baseline values were compared with post-procedural serum levels measured during the acute peri-procedural period (0–30 days), early recovery (31–90 days), intermediate recovery (91–180 days), late recovery (181–365 days), medium-term follow-up (1–2 years), and long-term follow-up (>2 years). Results: Free T3 demonstrated early suppression across all procedures, most pronounced in CABG during the acute peri-procedural period, with partial recovery at later timepoints. AVR showed moderate suppression at early and long-term follow-up, while PCI demonstrated minimal and inconsistent changes. Free T4 remained relatively stable across procedures, with limited significant post hoc differences after adjustment. TSH showed significant temporal variability in CABG and AVR but not in PCI. Serum albumin demonstrated marked early decline, most pronounced in CABG, with partial recovery over time, whereas AVR showed delayed long-term suppression. Data availability declined substantially at later timepoints across all biomarkers. Conclusions: In this retrospective exploratory analysis, CABG was associated with the most pronounced early perturbations in thyroid and albumin trajectories, while PCI and AVR demonstrated more heterogeneous temporal patterns. These findings are hypothesis-generating and should be interpreted cautiously given non-protocolized laboratory follow-up, substantial missingness, and potential selection bias.

Background: To compare 24-hour and 60-day survival after in-hospital cardiac arrest in overweight (BMI ≥ 25 kg/m ² ) and obese patients (BMI ≥ 30 kg/m ² ) resuscitated with LUCAS® assisted versus manual CPR, and to determine whether BMI modifies this association. Methods: Multicenter retrospective cohort of adult IHCA events at seven Mayo Clinic hospitals from January 2019 to January 2025. Cardiac arrests 0.14), indicating consistent effects across the BMI spectrum. Conclusion: In overweight and obese IHCA patients, LUCAS®-assisted mechanical CPR did not improve 24-hour or 60-day mortality versus high quality manual compressions, and effectiveness was independent of BMI.