Ventilator-associated pneumonia (VAP) rates are higher in low- and middle-income countries (LMICs) than in high-income countries (HICs).

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 American Heart Association guidelines recommend placement of an endotracheal tube either during CPR or shortly after return of spontaneous circulation, but do not provide guidance around intubation methods, including the choice of laryngoscope.

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 noncritically ill patient populations. Our objective was to assess the feasibility of a multicenter, randomized, placebo-controlled trial testing the hypothesis that low-dose melatonin prevents delirium in adults who are critically ill.

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 colonoscopy was performed, during which he experienced significant hypotension after being placed in the supine position and given anesthesia. The hypotension required treatment with vasoactive medications, termination of the colonoscopy, and transfer to the medical ICU for invasive hemodynamic monitoring and treatment.

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 he was treated symptomatically and discharged. After 4 months, the patient once again appeared with worsening respiratory distress and cough with fever. The dyspnea was not accompanied by orthopnea, pedal edema, or palpitation. The patient was admitted to the medical ICU. He had no history of arthralgia, myalgia, skin rash, or other signs of autoimmune disease. He denied any history of smoking, work-related or occupational exposures, drug intake, or recent travel.

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 symptoms resolved, and he was discharged from the hospital. Two months later, the patient presented again for the onset of dry cough and hemoptysis. Despite symptomatic treatment, his symptoms and chest CT scans had no improvement. Thereby, he was referred to our institution. He was prone to spontaneous bruising since childhood with a family history of spontaneous cerebral aneurysm. At 21 years of age, the patient underwent an appendectomy because of a suspected perforation. Also, he experienced cerebral hemorrhage 3 years earlier.

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 solid nodule with surrounding ground glass opacity (Fig 1B). With a suspicion of carcinoma in situ, right upper lobectomy was performed via video-assisted thoracoscopic surgery at the local hospital. However, the histologic examination did not show any evidence of malignancy, and the symptoms persisted. Fourteen months later, his dyspnea worsened with extremely low exercise tolerance. The patient denied other symptoms (eg, rash, fever, joint pain, aphthous stomatitis, genital ulceration, other symptoms of arteritis). His appetite was decreased but without significant weight loss. He did not smoke and had a history of fully recovered cerebral infarction 9 months ago. There was no family history of respiratory diseases. After 4 months, a CT pulmonary angiography scan revealed filling defects at the left pulmonary artery and left inferior pulmonary artery (Fig 2A). A vascular narrowing was detected at the left superior pulmonary artery. Accompanied with an increased D-dimer level (> 10 mg/L; normal range, 0-0.5 mg/L), a diagnosis of pulmonary embolism was made. The patient was treated with warfarin, and his symptom of dyspnea was partially relieved. He came to our hospital for further treatment 4 months later.