Effective bidirectional communication is crucial during end-of-life decision-making, which requires clear understanding between clinicians and patients/family members about treatment options, preferences, and goals of care. For those who have a non-English language preference (NELP), or who have difficulty speaking, reading, writing, and understanding English, interpreters are essential. However, patients

High flow nasal cannula (HFNC) is a first-line therapy for patients with acute respiratory failure. Despite increased HFNC utilization over recent years -accelerated in part by the Coronavirus Disease 2019 pandemic - high-quality evidence to guide HFNC discontinuation is lacking. Decisions about when and how quickly to reduce flow rate, fraction of inspired oxygen, or both simultaneously are frequently

BACKGROUND Pediatric pulmonary hypertension (PH) is a severe incurable disease with poor prognosis. In pediatric PH, trial design is hampered by the absence of age-appropriate trial endpoints. This study evaluated physical activity (PA) measured by hip-anchored accelerometry as a potential trial endpoint in pediatric PH. RESEARCH QUESTIONS Is PA-accelerometry associated with disease severity, and based

BACKGROUND The cuff leak test (CLT) is an important tool to assess the risk of upper airway obstruction after extubation. RESEARCH QUESTION Does modified CLT approach have superior ability in predicting re-intubation compared with traditional method? STUDY DESIGN AND METHODS This was a prospective, multicenter, randomized control trial. The primary end point was the incidence of the need for reintubation

BACKGROUND There is an ongoing debate about whether clearance of Mycobacterium tuberculosis infection occurs and at what magnitude. Recent studies quantifying 'uncertainty zones' of interferon-gamma release assays (IGRA) provide a more stringent estimate of reversion, potentially indicating clearance. RESEARCH QUESTION When accounting for 'uncertainty zones' through stringent cutoffs, what are the

BACKGROUND Patient-reported outcomes should be considered alongside clinical assessments to guide therapy for chronic obstructive pulmonary disease (COPD). RESEARCH QUESTION Does add-on dupilumab treatment improve health-related quality of life and respiratory symptoms in patients with COPD and type 2 inflammation? STUDY DESIGN AND METHODS In this pooled analysis of two phase 3 trials, patients with

Millions of people around the world survive critical illness each year only to realize that they and their loved ones are grappling with a new "normal" after hospital discharge for which their medical team may not have adequately prepared them. Up to half of all intensive care unit (ICU) survivors suffer from new or worsening impairments in physical, cognitive, and psychological domains of health that

BACKGROUND In 2019, Korea initiated the world's first national low-dose computed tomography (CT) lung cancer screening (LCS) program, adapting the Lung CT Screening Reporting and Data System (Lung-RADS) to counteract the high false-positive rates driven by prevalent tuberculosis. RESEARCH QUESTION Does the modified Lung-RADS enhance screening specificity while maintaining sensitivity? STUDY DESIGN

There is limited knowledge about long-term mortality, care pathways and health-related quality of life (HrQoL) among intensive care unit (ICU) patients receiving prolonged mechanical ventilation (PMV).

Alpha-1-Antitrypsin (A1AT) deficiency is a common hereditary disorder associated with increased risk of developing chronic obstructive pulmonary disease (COPD). Many individuals with severe A1AT deficiency go undiagnosed, or are diagnosed late, and fail to benefit from disease-specific counseling and modifying care. Since the 2012 Canadian Thoracic Society (CTS) A1AT deficiency clinical practice guideline

BACKGROUND Quoting patients in electronic medical record (EMR) notes is controversial. Quotations may be used to promote accuracy in documentation. However they also may be used to cast skepticism on patient speech. Little is known about how quotations are used in EMR notes documenting goal of care (GOC) conversations. RESEARCH QUESTION 1) How often are quotations used in GOC notes; 2) what content

BACKGROUND Survivorship after coronavirus disease 2019 (COVID-19) critical illness may be associated with important long-term sequelae, but little is known regarding mental health outcomes. RESEARCH QUESTION What is the association between COVID-19 critical illness and new post-discharge mental health diagnoses. STUDY DESIGN AND METHODS: We conducted a population-based cohort study in Ontario, Canada

BACKGROUND The optimal target for partial pressure of arterial carbon dioxide (PaCO₂) remains uncertain in patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) following out-of-hospital cardiac arrest (OHCA). RESEARCH QUESTION Are PaCO₂ levels associated with functional outcomes in patients receiving VA-ECMO after OHCA? STUDY DESIGN and Methods: This multicenter, registry-based

BACKGROUND Although small airway disease has been recognized as a major contributor to obstructive respiratory diseases, the association between occupational endotoxin exposure and small airway disease, as characterized by CT scans, requires further investigation. RESEARCH QUESTION What is the association between occupational endotoxin exposure and small airway disease, and which CT imaging biomarkers

TOPIC IMPORTANCE Education and psychosocial support are essential components of pulmonary rehabilitation (PR). However, the delivery of education often follows a one-size-fits-all approach, with individual factors that influence learning rarely considered. Moreover, education-related outcomes are frequently overlooked in PR assessments, and inconsistent use of these outcomes has limited our understanding

BACKGROUND Pulmonary rehabilitation (PR) is a beneficial intervention for people with interstitial lung disease (ILD), however the effect of PR on survival is unclear. This study compared the survival outcomes in people with ILD who were allocated to PR versus those who were allocated to control in two published randomised controlled trials (RCTs). RESEARCH QUESTION Does participation in PR impact

BACKGROUND Airway management is a critical component of the care of patients experiencing cardiac arrest, but data from randomized trials on the use of video vs direct laryngoscopy for intubation in the setting of cardiac arrest are limited. Current AHA guidelines recommend placement of an endotracheal tube either during CPR or shortly after return of spontaneous circulation but do not provide guidance

BACKGROUND Ventilator-associated pneumonia (VAP) rates are higher in low- and middle-income countries (LMICs) than in high-income countries (HICs). RESEARCH QUESTION Could differences in ventilator bundle adherence, ventilation practices, and critical care staffing be driving variations in VAP risk between LMICs and HICs? STUDY DESIGN AND METHODS This secondary analysis of the multicenter, international

BACKGROUND Delirium is a common and serious syndrome of acute brain dysfunction associated with negative outcomes. Melatonin may have a role in delirium prevention for critically ill adults based on data from non-critically ill patient populations. Our objective was to assess the feasibility of a multi-centre, randomized, placebo-controlled trial testing the hypothesis that low-dose melatonin prevents

TOPIC IMPORTANCE Accurate assessment of a patient's volume status is crucial in many conditions, informing decisions on fluid prescribing, vasoactive agents, and decongestive therapies. Determining a patient's volume status is challenging, due to limitations in examination and investigations and the complexities of fluid homeostasis in disease states. Point-of-care ultrasound (POCUS) is useful in assessing

Changes in body composition, including loss of muscle mass and obesity, adversely affect lung function.

BACKGROUND Adaptation of the right ventricle is a key determinant of outcomes in pulmonary arterial hypertension (PAH). Despite a compelling rationale to develop targeted therapies for the right ventricle in PAH, no such treatments exist. H2-receptor antagonism is a potential myocardial-focused paradigm in heart failure. RESEARCH QUESTION Do H2-receptor antagonists improve outcomes in participants

A 75-year-old patient with autosomal dominant polycystic kidney disease (ADPKD) and hypertension was admitted to the hospital with abdominal pain secondary to a choledochal cyst resulting in biliary dilation. His hospital course was complicated by pneumonia, encephalopathy, and lower gastrointestinal bleeding (LGIB) that initially did not lead to hemodynamic compromise. To further evaluate the LGIB

A 23-year-old man presented to the ED with a history of respiratory distress, cough, and fever for 10 days. He was evaluated in the ED, where he received a diagnosis of pulmonary edema, secondary to mitral regurgitation with mitral valve prolapse syndrome. He was treated with antibiotics and diuretics and discharged to home. Three months later, he returned to the ED with similar complaints, for which

A 34-year-old man who did not use tobacco complained of hemoptysis with a small volume, severe dry cough, and low-grade fever for 5 months. He denied dyspnea, chest pain, night sweats, or weight loss. Chest CT scanning showed nodules with a cavity in the lower left lung. Pathogenic tests of BAL fluid were negative. Initially, he was diagnosed with pneumonia and received antibiotics. After a week, his

A 51-year-old man presented with chest tightness, exertional dyspnea, and occasional chest pain for 2 years. The patient visited his local hospital initially, and CT scan revealed a ground glass opacity (GGO) located in the right upper lobe (Fig 1A). He was diagnosed as having pulmonary infection and treated with levofloxacin for 12 days. A repeated chest CT scan 14 days later demonstrated a progressed

High-flow nasal cannula (HFNC) has emerged as a promising intervention for postextubation oxygen therapy, with the potential to reduce the need for reintubation. However, it remains unclear whether using a higher flow setting provides better outcomes than the commonly used flow rate of 30 to 50 L/min.

Up to two-thirds of patients with severe uncontrolled asthma (SUA) who received biologic therapy do not have a complete response.

BACKGROUND The prevalence of chronic respiratory diseases is increasing globally. There is evidence that those with spirometric impairment, and no evidence of obstruction, termed preserved ratio impaired spirometry (PRISm), have increased risk of morbidity and mortality, compared to those with normal lung function. There remain several gaps in characterizing PRISm. RESEARCH QUESTIONS What is the prevalence

The small airways comprise generations 8 to 23 of the bronchial tree, consist of airways with an internal diameter < 2 mm, and are classically difficult to assess and treat in persistent asthma. Small airways dysfunction (SAD) is integral to the asthma management paradigm because it is associated with poorer symptom control and greater levels of type 2 inflammation, and it has been proposed as a potentially

A large number of symptomatic individuals with central sleep apnea (CSA) in clinical practice have an indication for adaptive servoventilation (ASV) therapy.

Pulmonary vascular disease (PVD), and in particular, pulmonary hypertension (PH), is a highly specialized area of medicine comprising complex diagnostics, classification systems, risk assessment tools, and therapeutics, the correct application of which has been shown to impact patient outcomes. The PVD scientific and patient community recognizes the importance of standardization of care patterns and

When an understanding of pathogenesis exists, skin lesions that have the appearance of blood in the skin can provide insight into the mechanisms leading to a systemic process that results in cutaneous manifestations. Of the vascular disturbances of the skin that occur in patients who are critically ill, some result from a nonhemorrhagic process, whereas others represent bleeding into the skin. The

Continuing data on racial bias in pulse oximeters and artificial intelligence have sparked calls for health systems to drive innovation against racial bias in health care device and artificial intelligence markets by incorporating equity concerns explicitly into purchasing decisions.