ROME, Italy — Pope Francis suffered two new acute respiratory crises Monday and was put back on noninvasive mechanical ventilation, in another setback to his battle to fight pneumonia, the Vatican said.

Doctors extracted “copious” amounts of mucus from his lungs during two bronchoscopies, in which a camera-tipped tube is sent down into the airways with a sucker at the tip to suction out fluid. The Vatican said the mucus was the body’s reaction to the original pneumonia infection and not a new infection, given laboratory tests don’t indicate any new bacteria.

Francis remained alert, oriented and cooperated with medical personnel. The prognosis remained guarded. Doctors didn’t say if he remained in stable condition, though they referred to the crises in the past tense, suggesting they were over.

The crises were a new setback in what has become a more than two-week battle by the 88-year-old pope, who has chronic lung disease and had part of one lung removed, to overcome a complex respiratory infection.

In a late update, the Vatican said the episodes were caused by a “significant accumulation” of mucus in his lungs and bronchial spasms. “Copious secretions,” were extracted during the bronchoscopies and the pope was put back on noninvasive mechanical ventilation, a mask that covers his nose and mouth and pumps oxygen into the lungs, the Vatican said.

The Vatican hasn’t released any photos or videos of Francis since before he entered the hospital on Feb. 14 with a complex lung infection. This has become the longest absence of his 12-year papacy.

The Vatican has defended Francis’ decision to recover in peace and out of the public eye. But on Monday one of Francis’ closest friends at the Vatican, Archbishop Vincenzo Paglia, urged him to let his voice be heard, saying the world needs to hear it.

“We need men like him who are truly universal and not only one-sided,” Paglia said, speaking after a press conference to launch the annual assembly of his Pontifical Academy for Life, the Vatican’s bioethics academy, which has as this year’s theme “The End of the World?”

Francis wrote a message to the assembly, dated Feb. 26, in which he lamented that international organizations are increasingly ineffective to combat the threats facing the world and are being undermined by “short-sighted attitudes concerned with protecting particular and national interests.”

It’s a theme he has articulated before. Francis also has repeatedly called for peace between Russia and Ukraine while trying to maintain the Vatican’s traditional diplomatic neutrality, and has tried to achieve a similar balancing act for Israel’s war with Hamas in Gaza.

Even a Vatican ambassador not especially close to Francis, Archbishop Georg Gaenswein, said the faithful needed to hear his voice at a time when war is raging in Europe. Gaenswein was Pope Benedict XVI’s longtime secretary, and Francis exiled him to be the Vatican ambassador in the Baltics after he published a memoir in 2023 that was critical of Francis.

“Pope Francis’ voice is of vital importance for all the world because he’s the only authority who speaks of peace, who condemns war, all the wars under way starting with Ukraine,” La Repubblica quoted Gaenswein as saying.

Francis’ 17-night hospitalization is by no means reaching the papal record that was set during St. John Paul II’s numerous lengthy hospitalizations over a quarter century.

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