Research Bronchoscopy Standards and the Need for Noninvasive Sampling of the Failing Lungs

Bain, William; Bastarache, Julie A.; Sarma, Aartik; McElvaney, Noel G.; Baron, Rebecca M.; McVerry, Bryan J.; Kitsios, Georgios D.

doi:10.1513/annalsats.202306-589le

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…For patient safety and practical purposes of subject participation in our observational research study, we relied on non-invasive biospecimens (ETA) for LRT microbiota profiling, as opposed to reference standard BAL. 38 Our non-invasive approach allowed us to enroll a large cohort of LRT specimens, follow serial samples over time, and is congruent with clinical practice guidelines for VAP diagnosis. 40 However, we may have missed important microbiota variability closer to the alveolar space, including a stronger signal of gut-to-lung microbiota translocation.…”

Section: Discussionmentioning

confidence: 81%

“…Thus, our comparative assessment of microbiota across body compartments highlights the clinical relevance of lung microbiota analysis in critical illness and the need for dedicated sampling of the LRT. 38 Second, the prognostic value of lung microbiota clusters was independent not only from clinical predictors and validated organ dysfunction metrics, such as the SOFA score, but also from the systemic host-response subphenotypes. Extensive evidence has established the prognostic value and generalizability of plasma biomarker-based subphenotyping of patients with ARF.…”

Section: Discussionmentioning

confidence: 97%

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Prognostic Insights from Longitudinal Multicompartment Study of Host-Microbiota Interactions in Critically Ill Patients

Kitsios,

Sayed,

Fitch

et al. 2023

Preprint

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Critical illness can disrupt the composition and function of the microbiome, yet comprehensive longitudinal studies are lacking. We conducted a longitudinal analysis of oral, lung, and gut microbiota in a large cohort of 479 mechanically ventilated patients with acute respiratory failure. Progressive dysbiosis emerged in all three body compartments, characterized by reduced alpha diversity, depletion of obligate anaerobe bacteria, and pathogen enrichment. Clinical variables, including chronic obstructive pulmonary disease, immunosuppression, and antibiotic exposure, shaped dysbiosis. Notably, of the three body compartments, unsupervised clusters of lung microbiota diversity and composition independently predicted survival, transcending clinical predictors, organ dysfunction severity, and host-response sub-phenotypes. These independent associations of lung microbiota may serve as valuable biomarkers for prognostication and treatment decisions in critically ill patients. Insights into the dynamics of the microbiome during critical illness highlight the potential for microbiota-targeted interventions in precision medicine.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 97%

Prognostic Insights from Longitudinal Multicompartment Study of Host-Microbiota Interactions in Critically Ill Patients

Kitsios,

Sayed,

Fitch

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

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Longitudinal multicompartment characterization of host-microbiota interactions in patients with acute respiratory failure

Kitsios,

Sayed,

Fitch

et al. 2024

Nat Commun

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Critical illness can significantly alter the composition and function of the human microbiome, but few studies have examined these changes over time. Here, we conduct a comprehensive analysis of the oral, lung, and gut microbiota in 479 mechanically ventilated patients (223 females, 256 males) with acute respiratory failure. We use advanced DNA sequencing technologies, including Illumina amplicon sequencing (utilizing 16S and ITS rRNA genes for bacteria and fungi, respectively, in all sample types) and Nanopore metagenomics for lung microbiota. Our results reveal a progressive dysbiosis in all three body compartments, characterized by a reduction in microbial diversity, a decrease in beneficial anaerobes, and an increase in pathogens. We find that clinical factors, such as chronic obstructive pulmonary disease, immunosuppression, and antibiotic exposure, are associated with specific patterns of dysbiosis. Interestingly, unsupervised clustering of lung microbiota diversity and composition by 16S independently predicted survival and performed better than traditional clinical and host-response predictors. These observations are validated in two separate cohorts of COVID-19 patients, highlighting the potential of lung microbiota as valuable prognostic biomarkers in critical care. Understanding these microbiome changes during critical illness points to new opportunities for microbiota-targeted precision medicine interventions.

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Research Bronchoscopy Standards and the Need for Noninvasive Sampling of the Failing Lungs

Cited by 2 publications

References 9 publications

Prognostic Insights from Longitudinal Multicompartment Study of Host-Microbiota Interactions in Critically Ill Patients

Prognostic Insights from Longitudinal Multicompartment Study of Host-Microbiota Interactions in Critically Ill Patients

Longitudinal multicompartment characterization of host-microbiota interactions in patients with acute respiratory failure

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