The edition · Top Clinical Updates
Prone positioning did not help children with early ARDS, and a triple agonist for sleep apnoea
A 75-unit trial stopped for futility found no gain from prone or oscillatory ventilation in paediatric ARDS, with more airway and pressure harms; retatrutide cut sleep apnoea severity by up to 24 events an hour.
The edition in brief
Today's cross-specialty edition opens with two phase 3 trials of retatrutide, an investigational weekly GIP, GLP-1 and glucagon receptor agonist, in adults with moderate-to-severe obstructive sleep apnoea and a BMI of at least 27 (NEJM, 21 October). At 80 weeks, the apnoea-hypopnoea index fell by 13 to 24 more events an hour than placebo in people without diabetes and by 9 to 15 more in those with type 2 diabetes, with weight loss of 12 to 22%. The drug is not approved anywhere. A Swedish case-control study of 624,713 first births (BMJ, 7 October) found quadrivalent HPV vaccination before pregnancy was associated with slightly lower odds of preterm birth (adjusted OR 0.95) — reassurance on safety rather than proof of benefit. The Dutch MIRA2 trial (Lancet, 21 October) found that inserting a levonorgestrel intrauterine system straight after endometrial ablation cut hysterectomy at two years from 10% to 4% without more serious complications. The pearl covers when prone positioning does help: adults with moderate-to-severe ARDS. The practice changer is PROSpect (Lancet, 31 October): in 424 children with early moderate-to-severe ARDS across 75 intensive care units, neither prone positioning nor high-frequency oscillatory ventilation improved ventilator-free days, while prone positioning increased airway blockage and pressure injuries and oscillation increased haemodynamic instability. The trial stopped early for futility, and its authors advise against routine first-line use of either strategy in this group.
Retatrutide reduced sleep apnoea severity in two phase 3 trials
Large drug-induced weight loss reduces sleep apnoea severity, but retatrutide is investigational and CPAP remains first-line.
HPV vaccination before pregnancy was linked to slightly fewer preterm births
Prior HPV vaccination was not linked to any pregnancy harm in over 600,000 births; use that to reassure hesitant patients.
A hormonal coil at ablation more than halved later hysterectomy
Adding a levonorgestrel coil at endometrial ablation lowered two-year hysterectomy from 10% to 4% without extra harm.
Prone positioning is still standard in adults with moderate-to-severe ARDS
Paediatric findings do not change adult ARDS care, where prone positioning remains standard for moderate-to-severe disease.
Prone positioning and oscillation did not help children with early ARDS
In early moderate-to-severe paediatric ARDS, prone positioning and oscillatory ventilation gave no benefit and added harm; avoid them as routine first-line care.
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