Chest
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A 72-year-old man with metastatic pancreatic cancer was admitted to the ICU with increased oxygen demand and confusion, likely related to pulmonary metastases. In the presence of his son, the health care agent, and the team, the patient requested to be do-not-attempt-resuscitation (DNR) and do-not-intubate (DNI) before losing decision-making capacity. ⋯ Numerous discussions over subsequent days revolved around the attempt to honor the patient's wishes in the setting of the surrogate's unwillingness or inability to make decisions in alignment with his father's wishes. This case reviews and analyzes the ethical options available to the clinical team in responding to requests for potentially inappropriate treatment at a patient's end of life and explores the roles of relational autonomy, beneficence vs nonmaleficence, and holding the balance of clinicians' and ethicists' professional, legal, and ethical responsibilities.
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Lower respiratory tract infections are common in patients receiving invasive mechanical ventilation in an ICU after an acute brain injury and may have deleterious consequences. ⋯ International Prospective Register of Systematic Reviews; No.: CRD42023424732; URL: https://www.crd.york.ac.uk/prospero/.
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Evaluating expiratory airway function in infants is challenging because the criterion standard, the raised-volume rapid thoracoabdominal compression technique, is technically difficult and has a high failure rate. ⋯ The passive flow-volume curve offers reliable and reproducible data with high correlation to the forced flow-volume curve. Therefore, the passive flow-volume curve can serve as an alternative tool in evaluating expiratory airway function in infants.
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The serum antiglycopeptidolipid core IgA antibody test has been proposed as a diagnostic tool for Mycobacterium avium complex pulmonary diseases. Cross-reactivity with other nontuberculous mycobacteria (NTM), including Mycobacterium abscessus, indicates that it may have a role as a broader screening test for nontuberculous mycobacterial pulmonary disease (NTM-PD). NTM-PD is believed to be underdiagnosed in patients with bronchiectasis. ⋯ gov.
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COPD management is guided by the respiratory symptom burden, assessed using the modified Medical Research Council (mMRC) scale, the COPD Assessment Test (CAT), or both. ⋯ gov.