BACKGROUNDTreatment outcomes and long-term survival of non-tuberculous mycobacterial pulmonary disease (NTM-PD) in a real-world setting are difficult to assess, especially for species other than Mycobacterium avium complex (MAC).METHODSThis was a retrospective cohort study on all Croatian residents with respiratory NTM isolates from 2006 to 2015, with follow-up to 2020.RESULTSTherapy was started in 98/137 (71.5%) of patients, significantly more often in patients with fibrocavitary disease and/or sputum smear positivity. Unsuccessful treatment outcomes were recorded in 39/98 (39.8%) patients (14 deaths and 25 treatment failures). One-year and 5-year all-cause mortality were respectively 18.2% and 37.6%. Guideline-based treatment (GBT) was started in 50/98 (51%) of treated patients and followed for the recommended duration in 35.7% (35/98). This resulted in a higher chance of cure (OR 3.79, 95% CI 1.29 to 11.1; P = 0.012) than inadequately treated/untreated patients. For Mycobacterium xenopi disease, high cure rates (>80%) were achieved both with GBT and non-GBT treatment regimens.CONCLUSIONGuideline-based therapy resulted in a four-time higher chance of being cured. The impact of GBT on treatment outcomes was clear for MAC disease, but no apparent effect was observed for patients with M. xenopi disease.

Background/Objectives: The use of intraoperative venoarterial extracorporeal life support (VA ECLS) has traditionally been used to support unstable patients undergoing complex lung transplantation. More evidence is emerging that the use of intraoperative VA ECLS may be beneficial for all patients undergoing lung transplantation. The aim of this study was to report the safety and feasibility of lung transplantation with the routine use of central VA ECLS. Methods: In this single-center retrospective observational study, all consecutive patients undergoing lung transplantation from April 2021 until September 2025 were included. Early outcomes and the incidence of primary graft dysfunction were evaluated with the International Society for Heart and Lung Transplantation criteria at 72 h after transplantation. Survival and chronic lung allograft dysfunction (CLAD)-free survival were reported with Kaplan–Meier estimates and 95% confidence intervals (CIs). Results: During the study period, 35 patients were successfully transplanted with the aid of central VA ECLS. There were no complications associated with intraoperative ECLS. One revision surgery was performed for immediate postoperative bleeding, and one for bronchial anastomosis air leak. Operative mortality occurred in three patients (8.6%). The median in-hospital stay was 30 (25–43) days. Severe primary graft dysfunction at 72 h was observed in four (11.4%) patients. Survival and CLAD-free survival at 1-, 3-, and 5-years following surgery were 85% (95% CI [74–98]), 74% (95% CI [59–92]), 67% (95% CI [28–82]), and 82% (95% CI [70–96]), 52% (95% CI [37–74]), 36% (95% CI [11–59]), respectively. Conclusions: Lung transplantation can safely be performed with the aid of central VA ECLS, with a low rate of primary graft dysfunction and favorable long-term outcomes. Further follow-up studies and greater experience are needed to make inferences on the long-term outcomes. This technique is relatively recent and evolving, representing an innovative intersection of advanced supportive technology with transplant surgery, potentially broadening indications and improving success rates.

Tracheal complications should be suspected in mechanically ventilated COVID-19 survivors with respiratory symptoms. Treatment requires a multimodal approach of interventional bronchoscopy and surgery with tight follow-up due to a high rate of restenosis. https://bit.ly/3iw05xQ.

Introduction: guidelines for nontuberculous mycobacterial pulmonary disease (NTMPD) treatment are mainly based on cohort studies and data on M. avium complex (MAC). Methods: retrospective analysis of all Croatian residents with respiratory NTM isolate from 2006 to 2016. ATS/IDSA guidelines were used for NTMPD definition. Cure was defined as multiple negative cultures at the end of treatment or at 12 months follow-up in case of shorter regimens. Regimens were grouped as: tuberculosis (TB), adequate NTM (NTM), <12 months adequate NTM (short NTM). Results: 137 cases of NTMPD (mean age 66.5; 52.6% males) were mostly caused by M.xenopi (n=54), and MAC (n=53). Median follow up was 60.47 months. 5-year all-cause mortality amounted to 36.5%. 38/137 had cavitary form; 47/114 were smear positive. Therapy was started in 98 (71.5%) cases - TB in 43.9%, NTM in 31.6%, and short NTM in 15.3% and cases. Cure was achieved in 64.7%, 82.8%, and 64.3% of patients finishing TB, NTM, and short NTM regimen, respectively. Patients receiving adequate therapy had 4x higher chance (p=0.012) of cure compared to ones receiving other regimen or no therapy. Therapy was started in 34 (89.5%) cases of cavitary NTMPD. Cure was achieved in 63.6% on TB and 83.3% on NTM therapy. 43 (91.5%) smear positive cases received treatment. Cure was achieved in 46.7% on TB and 75% on NTM therapy. In smear negative patients, regardless of NTMPD form, all regimens resulted with similar cure rates (over 80%). Conclusions: smear status and cavitary disease were major factors influencing therapy initiation. Adequate NTM regimens significantly improved overall cure rate but seem to be of highest importance in „heavier“disease forms (i.e. smear positive and/or cavitary).