Over 300,000 patients experience in-hospital cardiac arrest in the United States each year, resulting in substantial morbidity, mortality, and loss of disability-adjusted life years. Although survival after in-hospital cardiac arrest has improved over the past 2 decades, outcomes remain poor and many initial survivors of in-hospital cardiac arrest are discharged with substantial disability. Across the United States, risk-standardized survival after in-hospital cardiac arrest varies significantly, reflecting potential for process improvement. Improving processes of care and outcomes after in-hospital cardiac arrest is a priority of national organizations such as the Joint Commission, the American Hospital Association, and other professional bodies. Nevertheless, best approaches to improving in-hospital cardiac arrest care have not been well defined. Performance of regular multidisciplinary in situ cardiac arrest simulations has been identified as a trait common to best performing hospitals with respect to in-hospital cardiac arrest outcomes. However, no clear approach to establishing an in situ cardiac arrest program has been established. In this How I Do It installment, we describe the creation of a robust and sustainable in situ cardiac program including securing sponsorship and assembling a multidisciplinary team, acquiring and maintaining equipment and resources, execution of realistic simulations, and facilitating structured debriefings and continuous quality improvement. Our framework and ready-to-use tools will enable hospitals to implement sustainable in situ in-hospital cardiac arrest simulation programs and drive measurable improvements in care and outcomes.

Interstitial lung disease (ILD) is a term encompassing a wide array of pulmonary conditions characterized by inflammation and fibrosis of the pulmonary parenchyma. Pulmonary hypertension (PH) is frequently encountered in patients with fibrotic ILDs and poses unique difficulties for both diagnosis and management. Patients with ILD-associated pulmonary hypertension (ILD-PH) are complex, often ailing and presenting with multiple comorbidities whose individual contributions to the underlying PH can be challenging to disentangle. Evidence supporting treatment with PH-specific medications in ILD-PH is limited. This edition of "How I Do It" presents a longitudinal case-based discussion of ILD-PH to address these challenges, highlight pearls and pitfalls in the diagnostic workup of these patients, and provide a framework for the practical evidence-based approach to accurate diagnosis and management of these challenging cases.

Air pollution and extreme temperature exposure during pregnancy is associated with lung function in schoolchildren.

Peer support could be beneficial for smoking cessation. Randomized controlled trial (RCT) evidence is lacking regarding mobile-based behavioral support offered by ex-smoking peers on smoking cessation in community people who smoke.

Breathlessness on exertion is a common, distressing, and limiting symptom that can be quantified on incremental cardiopulmonary exercise testing (CPET) using normative reference equations.

Many patients are unaware of the need to repeat lung cancer screening (LCS) annually despite shared decision-making. A health communication intervention was tested to improve patient knowledge, tobacco-related stigma, and self-efficacy in LCS.

The population-level impact of risk factors for unfavorable TB treatment outcomes depends on their relative prevalence in the population. Unadjusted and adjusted attributable fractions (AFs) were calculated to estimate the proportion of unfavorable TB treatment outcomes that can be attributed to key risk factors in India.

Fibrinolysis and complicated parapneumonic effusion/empyema have a longstanding relationship. Many of the first major breakthroughs in the discovery of plasminogen and its activators were made using Streptococcus species isolated from a patient with empyema. Fatefully, the first clinical use of plasminogen activators to treat human disease involved administering the identified streptococcal plasminogen activator, streptokinase, intrapleurally to treat parapneumonic effusion and empyema. Refinement of fibrinolytic therapy has led to the common practice of adjunctive intrapleural fibrinolytic therapy, using a combination of recombinant human tissue plasminogen activator and deoxyribonuclease-1. However, current intrapleural fibrinolytic therapy is inefficient, resulting in an average hospital stay of 14 days. Further, many patients demonstrate residual pleural effusion after therapy, some of whom ultimately require surgery. This leads to billions of dollars of health care expenditure annually in the United States. This review aims to provide a historical overview of intrapleural fibrinolysis, review the current clinical fibrinolytic therapy practices for treatment of complicated parapneumonic effusion/empyema, and highlight knowledge gaps in our understanding of the pathobiology of resistance to intrapleural fibrinolytic therapy. Although nonfibrinolytic modalities such as pleural irrigation and surgery are referenced for context, they are not the focus of this review and are not discussed in depth. Improved knowledge of the mechanisms underlying aberrant fibrinolysis in the pleural space has the potential to improve prognostication, guide precision therapeutics, and enhance the care of patients with complicated parapneumonic effusion/empyema, leading to better individual outcomes and reduced health care expenditure.

Uptake of evidence-based practices (EBPs) in pulmonary and critical care medicine is frequently incomplete. To address these gaps, implementation scientists seek to understand the clinical and societal contexts in which innovations and EBPs are introduced. They also design and evaluate complex interventions to facilitate the adoption of an EBP in those contexts. We propose that well-established methods for analyzing hierarchical, observational data can complement and strengthen this process by identifying sources of practice variability. This paper reviews the dominant framework used to understand the clinical context of implementation programs, describes how measuring practice variability could help streamline this approach, and tests an assumption of the proposed combined methodology using observational data from a national study of patients on mechanical ventilation conducted by the Prevention and Early Treatment of Acute Lung Injury Network. We discuss how the combined approach can be used (1) to focus the search for determinants of practice, (2) to quantify the impact of evidence generation and evaluate the success of implementation projects, and (3) to facilitate comparisons between implementation strategies when multiple approaches are trialed simultaneously.

In a context of overwhelming demand, mass transfers between ICUs were organized in France during the first COVID-19 epidemic wave (spring 2020). According to early reports, transferred patients experienced a 3- to 4-fold lower ICU case fatality. It is not known whether this difference stems only from the selection of healthier patients for transfer.

Mycobacterium abscessus complex (MABC) is a major causative pathogen of nontuberculous mycobacterial pulmonary disease (PD) and is notoriously difficult to treat. However, the impact of culture conversion on survival has not been explored in previous studies. Herein, we investigated the relationship between culture conversion and mortality in patients with MABC-PD.