Treatment Selection in Pulmonary-Critical Care Medicine : A Dissertation Submitted in Satisfaction of the Requirements

Pitre, Tyler (2025) Treatment Selection in Pulmonary-Critical Care Medicine : A Dissertation Submitted in Satisfaction of the Requirements. Doctoral thesis, University of East Anglia.

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Abstract

This PhD by publication applies advanced evidence synthesis to address clinical uncertainty in pulmonary and critical care medicine, focusing on heterogeneity in chronic obstructive pulmonary disease, interstitial lung disease, acute hypoxemic respiratory failure and sepsis. It investigates non-invasive oxygenation strategies (high-flow nasal cannula, non-invasive ventilation, conventional oxygen) and corticosteroids (inhaled, systemic) across diverse respiratory contexts to enhance clinical evidence precision.

Through systematic reviews and meta-analyses published in journals like Annals of ATS, CHEST, Intensive Care Medicine and The Lancet Respiratory Medicine, the research employs pairwise, network and dose-response meta-analytic techniques. Key findings include high-flow nasal cannula reducing COPD exacerbations, helmet continuous positive airway pressure lowering mortality in acute settings and corticosteroids showing limited efficacy in fibrotic interstitial lung disease but dose-dependent benefits in severe COVID-19, sepsis and community-acquired pneumonia. Moderate-certainty evidence supports non-invasive ventilation for preventing hypoxemia during intubation and corticosteroids for reducing mortality in severe pneumonia and sepsis.

Informing the Society of Critical Care Medicine’s 2024 guidelines, the thesis highlights practical impacts despite challenges like conflicting trial results (e.g., REMAP-CAP). It demonstrates advanced meta-analytic methods’ utility in synthesizing heterogeneous evidence, laying a foundation for future biomarker-driven and protocol-standardised research to advance evidence-based, patient-centred care.

Item Type:	Thesis (Doctoral)
Uncontrolled Keywords:	Publication
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	17 Dec 2025 08:36
Last Modified:	17 Dec 2025 08:36
URI:	https://ueaeprints.uea.ac.uk/id/eprint/101443
DOI:

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