Chronic obstructive pulmonary diseases (Miami, Fla.) · 2026
Comparison of Nebulized Long-Acting Muscarinic Antagonist Revefenacin to Ipratropium in COPD Patients With Acute Respiratory Failure Requiring Mechanical Ventilation: Results of the RARICO Study.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Barjaktarevic Igor, Dartt Matthew, Chen Siyan, Champion D'Mitri, Mempin Roberto, Dejsatha Yongyus, Van Vleet Joseph, Chang Steven, Estrada Oscar, Young Timothy, Buhr Russell, Tashkin Donald, Bando Joanne M
Аннотация
BACKGROUND: Revefenacin is a nebulized long-acting muscarinic antagonist approved for maintenance therapy in stable chronic obstructive pulmonary disease (COPD). We conducted a pilot study to evaluate the feasibility and safety of revefenacin in mechanically ventilated COPD patients with acute respiratory failure (ARF), and compare its use with the short-acting muscarinic antagonist ipratropium, the current standard inpatient therapy.
METHODS: In this double-blind, randomized controlled pilot study, intubated COPD patients were assigned to revefenacin 175mcg once daily plus three placebo doses, or ipratropium 500mcg via vibrating mesh nebulizer every 6 hours, for up to 7 days. The primary endpoints were safety and feasibility; exploratory endpoints included ventilator-derived respiratory mechanics and clinical outcomes.
RESULTS: Twenty-one patients (mean age 76±11 years, 60±51 pack years smoking, percent-predicted FEV1 56±26%) were randomized to revefenacin (N=12) or ipratropium (N=9). Duration of mechanical ventilation was similar between groups (2.5±2.3 vs 3.6±2.8 days; P=0.83), with similar number of administered doses (2.8±2.1 vs 14.2±11.1; P=0.74). Daily nebulization time was significantly lower with revefenacin (7.2±1.0 vs 26.8±5.3 minutes; P<0.01). Adverse events were infrequent and comparable between the groups. Revefenacin improved dynamic resistance (Rdyn) post-dose (-0.9 vs +2.6 cmH₂O/L/s; P<0.01), without differences in peak inspiratory, resistive, or plateau pressures.
CONCLUSION: Once-daily nebulized revefenacin is a feasible and safe alternative to ipratropium in mechanically ventilated COPD patients with ARF, with reduced time spent on nebulization adminitration. Improvements in airway resistance suggest a potential physiologic benefit, warranting further investigation.
METHODS: In this double-blind, randomized controlled pilot study, intubated COPD patients were assigned to revefenacin 175mcg once daily plus three placebo doses, or ipratropium 500mcg via vibrating mesh nebulizer every 6 hours, for up to 7 days. The primary endpoints were safety and feasibility; exploratory endpoints included ventilator-derived respiratory mechanics and clinical outcomes.
RESULTS: Twenty-one patients (mean age 76±11 years, 60±51 pack years smoking, percent-predicted FEV1 56±26%) were randomized to revefenacin (N=12) or ipratropium (N=9). Duration of mechanical ventilation was similar between groups (2.5±2.3 vs 3.6±2.8 days; P=0.83), with similar number of administered doses (2.8±2.1 vs 14.2±11.1; P=0.74). Daily nebulization time was significantly lower with revefenacin (7.2±1.0 vs 26.8±5.3 minutes; P<0.01). Adverse events were infrequent and comparable between the groups. Revefenacin improved dynamic resistance (Rdyn) post-dose (-0.9 vs +2.6 cmH₂O/L/s; P<0.01), without differences in peak inspiratory, resistive, or plateau pressures.
CONCLUSION: Once-daily nebulized revefenacin is a feasible and safe alternative to ipratropium in mechanically ventilated COPD patients with ARF, with reduced time spent on nebulization adminitration. Improvements in airway resistance suggest a potential physiologic benefit, warranting further investigation.