Annals of the American Thoracic Society
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Bedside diagnosis, including but not limited to the physical examination, can be lifesaving in the setting of critical illness and is a core competency in both medical school and at the postgraduate level. Data as to the clinical usefulness of bedside diagnosis in the modern intensive care unit (ICU) is sparse, however, and there are no clinical guidelines addressing performance, interpretation, and usefulness of the bedside assessment in critically ill patients. Bedside assessment and physical examination are used in a heterogeneous manner across institutions and even across ICUs within the same institution, which has implications for medical education, patient care, and the overuse/misuse of diagnostic testing. In this commentary, we review the existing data addressing bedside diagnosis in the ICU, describe various models of bedside assessment use in the ICU based on our clinical practice and on the limited evidence base, share our practical "checklist-based" approach to bedside assessment in the critically ill patient, and advocate for more formal study of physical examination and bedside assessment in the ICU to enhance clinical practice.
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The American Thoracic Society (ATS) previously published standards for Flexible Airway Endoscopy (FAE) in children in the American Review of Respiratory Diseases in 1992 [1]. Since that time there have been significant advances in the field with expansion in the use of FAE for diagnostic and therapeutic purposes. ⋯ The technical standards describe the equipment, personnel, competencies, and procedures necessary for pediatric FAE. This summary is prepared for practicing clinicians.
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Prognostic models can inform management decisions for patients requiring prolonged mechanical ventilation. The ProVent score was developed to predict one-year mortality in these patients. External evaluation of such models is needed before they are adopted for routine use. ⋯ The modified ProVent model was accurate in our cohort. This supports its geographic and temporal generalizability. It can also accurately identify patients at risk of one-year mortality at day 14 of mechanical ventilation, but additional confirmation is required. Further studies should explore the implications of adopting the model into routine use. 347 words .
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Multicenter Study Comparative Study
Symptom Burden of Chronic Lung Disease Compared with Lung Cancer at Time of Referral for Palliative Care Consultation.
A growing evidence base supports provision of palliative care services alongside life-prolonging care. Whereas palliative care processes have been implemented widely in the care of patients with lung cancer, the same is not true for patients with chronic, progressive lung disease. ⋯ Patients with chronic lung disease have symptom burdens similar to those of patients with lung cancer at the time of first palliative care encounter. Given the population burden of chronic lung disease and limitations in the palliative care workforce, attention should be focused on ensuring that pulmonologists are prepared to assess and manage the common palliative care needs of patients with chronic lung disease.