Chest
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COPD is a progressive debilitating disease with diminished quality of life after hospital admissions. Because of the nature of the disease, it is important to address patients' goals of care, preferably prior to the development of refractory COPD. Advance Care Planning (ACP) is an all-encompassing term that involves discussing goals with patients. ⋯ Research addresses the reason that advance care planning is important, yet there are barriers that patients, families, and health care providers encounter that prevent meaningful discussions. Research has also found that the use of multidisciplinary teams improves care and quality of life; however, research should be dedicated to the investigation of the effects of advance care planning initiatives on outcomes in patients with COPD, particularly in the reduction of hospital admissions and improvement of quality of life. This review seeks to educate providers about end-stage COPD and advance care planning, the evidence that shows the importance of advance care planning, and the current and future state of research.
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Severe forms of pulmonary embolism (PE) in children, althought rare, cause significant morbidity and mortality. We review the pathophysiologic features of severe (high-risk and intermediate-risk) PE and suggest novel pediatric-specific risk stratifications and an acute treatment algorithm to expedite emergent decision-making. We defined pediatric high-risk PE as causing cardiopulmonary arrest, sustained hypotension, or normotension with signs or symptoms of shock. ⋯ Acute management of severe PE in children may include systemic thrombolysis, surgical embolectomy, catheter-based therapies, or anticoagulation alone and may depend on patient and institutional factors. Pediatric emergency and intensive care physicians should be familiar with the risks and benefits of each therapy to expedite care. PE response teams also may have added benefit in streamlining care during these critical events.
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Nontuberculous mycobacterial pulmonary disease (NTM-PD) continues to impose a significant clinical burden of disease on susceptible patients. The incidence of NTM-PD is rising globally, but it remains a condition that is challenging to diagnose and treat effectively. This review provides an update on the global epidemiologic features, risk factors, and diagnostic considerations associated with the management of NTM-PD.
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Multicenter Study Observational Study
Bronchial Thermoplasty in Severe Asthmatics At 5 Years: The PAS2 Study.
Bronchial thermoplasty is a device-based treatment for subjects ≥ 18 years of age with severe asthma poorly controlled with inhaled corticosteroids and long-acting beta-agonists. The Post-FDA Approval Clinical Trial Evaluating Bronchial Thermoplasty in Severe Persistent Asthma (PAS2) study collected data on patients with severe asthma undergoing this procedure. ⋯ gov.
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ARDS is an inflammatory condition of the lungs and is a common condition in adult ICUs. The resources required and costs of care for patients with ARDS are significant because of the severity of the illness and extended ICU lengths of stay. ⋯ A wide range of costing data is available for ARDS. A comprehensive synthesis of this literature frames the reasons for this and allows estimates to reflect the context in which they were assessed. This information will be of value to researchers and administrators interested in the economics of caring for patients with ARDS.