2-Deoxy-2-[18F]fluoro-d-glucose (FDG)-PET/CT imaging has utility in identifying sites of active sarcoidosis. However, the role of FDG-PET/CT imaging in predicting treatment response and guiding therapy outside of cardiac disease is yet to be completely understood.

Electromagnetic navigation bronchoscopy (ENB) is an advanced imaging-guided technique used to diagnose peripheral pulmonary lesions. However, the optimal strategy for selecting biopsy devices remains unclear.

Double-blind peer review (DBPR; reviewers masked to author identities and vice versa) aims to reduce biases. The effectiveness of DBPR has not been studied in pulmonary, critical care, and sleep journals.

Accurate risk stratification is critical aspect of pulmonary arterial hypertension (PAH) management. It is unclear whether main pulmonary artery (MPA) enlargement offers additional prognostic value to validated risk scores.

Improved childhood management strategies have decreased the early life morbidity and mortality of severe developmental lung disorders, such that an increasing number of individuals ultimately transition care to adult pulmonologists for management. Alternatively, individuals with milder malformations may present in adulthood or may have an increased risk for the development of more common adult pulmonary comorbidities (eg, COPD, pulmonary hypertension). As such, there is a critical need for adult pulmonologists to understand how developmental lung disorders may impact respiratory morbidity over the lifespan.

The immediate postoperative period after heart surgery poses a substantial risk of life-threatening complications, notably acute pulmonary and cardiac failure. Use of noninvasive ventilation (NIV) may reduce the incidence of pulmonary or heart failure, or both.

Balanced crystalloid solutions may improve clinical outcomes compared with saline for some critically ill adults, but it is unclear whether differences in composition between balanced crystalloid solutions affect outcomes.

Continuous glucose monitors (CGMs) could potentially improve management of hyperglycemia compared with standard point-of-care glucose monitoring for critically ill patients. However, there is limited evidence to support routine use of CGMs in the ICU.

Previous clinical data suggest that the presence of a pleural effusion is associated with poor survival. However, these studies were limited by either a small sample size or lack of an adequate control group.

Preserved ratio impaired spirometry (PRISm) findings are heterogeneous and include restrictive lung disease. Interstitial lung abnormalities (ILAs) may represent early interstitial lung disease. The relationship between PRISm and ILAs is not well understood.

A 21-year-old man with a history of glucose-6-phosphate dehydrogenase deficiency experienced an acute onset of atraumatic left upper abdominal and flank pain. An initial contrast-enhanced CT scan of the chest, abdomen, and pelvis revealed a consolidation in the left lower lobe, a small pleural effusion, and enlarged mesenteric lymph nodes. The patient was prescribed nonsteroidal antiinflammatory drugs for a presumed viral syndrome and was discharged. He returned the next day with increased pain, new onset of shortness of breath, and a fever of 38.6 °C. A diagnosis of community-acquired pneumonia was made, and doxycycline was prescribed. Twenty-four hours later, he presented again with severe pain, worsening dyspnea, and hypoxemia. A CT angiogram of the chest showed persistent consolidation in the left lower lobe and a now large left pleural effusion. He was admitted to the internal medicine service for the management of pneumonia and presumed para-pneumonic effusion.

A 40-year-old man with chronic myeloid leukemia presented to the hospital with recurrent dyspnea and hypoxemic respiratory failure. He presented from his outpatient transplant infectious diseases appointment with dyspnea, cough, worsening hypoxemia, acute kidney injury, and somnolence after discharge from the hospital 2 weeks prior with a similar presentation. During the previous hospital stay, he underwent bronchoscopy and alveolar lavage with negative infectious workup. He was prescribed caspofungin, amphotericin, and continued posaconazole for prior probable invasive fungal infection (elevated blood BD-glucan and pulmonary nodules). Antibiotics included previous meropenem for esophageal nocardiosis, cefepime and azithromycin during admission, and now ceftriaxone for nocardiosis in the outpatient setting for convenience of home infusion. He was prescribed diuretics for presumed volume overload. Despite home diuretics, antimicrobials, and supplemental oxygen, he re-presented with worsening symptoms.

A 56-year-old woman was admitted to our hospital, presenting with a history of recurrent fevers persisting for over 2 months. The febrile episode was self-limiting, accompanied by cough without significant expectoration, with the fever predominantly manifesting during the afternoon and evening hours. Furthermore, there were no concurrent symptoms indicative of chest tightness, wheezing, dyspnea, or hemoptysis. A CT scan in a local hospital demonstrated multifocal lymphadenopathy in the mediastinum and bilateral supraclavicular regions. The patient had neither a history of tobacco usage nor of alcohol consumption. Furthermore, there was no familial history of oncologic conditions. The patient's medical records revealed no evidence of hypertension, diabetes mellitus, coronary artery disease, infectious diseases, or immunologic disorders.

Pulmonary arterial hypertension (PAH) frequently is associated with an imbalance in antiproliferative bone morphogenic protein-2 receptor signaling and proproliferative type-II activin receptor signaling, favoring the latter. Sotatercept is an activin ligand trap that reduces the dominant detrimental activin signaling and provides clinical benefit. We report a patient with heritable PAH in whom sotatercept had neither positive nor negative effects; we relate that fact to his PAH being caused by a previously unreported variant of unknown significance (c.1276T>C, p.[Cys426Arg]) in the GDF2 gene. GDF2 encodes bone morphogenic protein type-9, the presence of which is required for proper functioning of the pulmonary microvasculature. Low levels of functionally active bone morphogenic protein type-9 contribute to PAH. As we enter an era of precision medicine for patients with PAH with increasingly costly therapies, genetic screening may direct appropriate therapy and limit the use of expensive but likely ineffective therapies.

High-flow nasal cannula (HFNC) is a first-line therapy for patients with acute respiratory failure. Despite increased HFNC utilization over recent years-accelerated in part by the COVID-19 pandemic-high-quality evidence to guide HFNC discontinuation is lacking. Decisions about when and how quickly to reduce flow rate, Fio2, or both simultaneously are frequently left to clinicians' discretion without clear guidance on an optimal approach. Failure to de-escalate HFNC support when clinically appropriate has many potential consequences, such as prolongation of ICU/hospital length of stay, increased health care costs, and reduced availability of limited hospital resources. With the goal of improving care efficiency and resource utilization among hospitalized patients with acute respiratory failure, we propose a standardized approach for HFNC discontinuation focused on "liberation" (similar to spontaneous breathing trials for patients undergoing mechanical ventilation), using a stepwise approach guided by physiology.

Effective bidirectional communication is crucial during end-of-life decision-making, which requires clear understanding between clinicians and patients and their family members about treatment options, preferences, and goals of care. For those who have a non-English language preference or who have difficulty speaking, reading, writing, and understanding English, interpreters are essential. However, patients who speak rarer languages, known as languages of lesser diffusion (LLDs), such as Karen, spoken in Thailand and Myanmar, face unique challenges because of limited interpretation resources. In this work, we discuss the case of a Karen-speaking patient admitted to the ICU who lacked decision-making capacity, requiring the involvement of family members who also spoke Karen for a code status discussion. Despite efforts to find an interpreter, no Karen interpreter was available initially, complicating the communication and decision-making about changing the code status to do not resuscitate/do not intubate. A remote Karen interpreter was identified later, allowing for effective communication and clinician assurance that the family did understand the implications of their decision and had made it voluntarily. End-of-life decision-making is complex and challenging, requiring culturally sensitive communication. Patients who speak LLDs face unique difficulties in these discussions compared with those who speak more common languages because of the lack of interpretation resources. The purpose of this case report is to draw attention to these specific challenges and explore ethical concerns when engaging in decision-making conversations with patients and families who speak an LLD.

Pediatric pulmonary hypertension (PH) is a severe incurable disease with a poor prognosis. In pediatric PH, trial design is hampered by the absence of age-appropriate trial end points. This study evaluated physical activity (PA) measured by hip-anchored accelerometry as a potential trial end point in pediatric PH.

The cuff leak test (CLT) is an important tool to assess the risk of upper airway obstruction after extubation.

There is an ongoing debate about whether clearance of Mycobacterium tuberculosis infection occurs and at what magnitude. Recent studies quantifying "uncertainty zones" of interferon-gamma release assays (IGRAs) provide a more stringent estimate of reversion.

Patient-reported outcomes should be considered alongside clinical assessments to guide therapy for COPD.