EDITORIAL| VOLUME 164, ISSUE 4, P826-828, OCTOBER 2023 Breaking a Sweat to Catch Your Breath: Exercise Therapy Improves Dyspnea After Acute Pulmonary Embolism Alexander E. Sullivan, Evan L. Brittain Chest 2023; 164: 826-828 DOI:https://doi.org/10.1016/j.chest.2023.05.033 Acute pulmonary embolism (PE) is a sentinel event for many patients; despite guideline-directed treatment of the acute event, up to 50% of patients will experience a pattern of dyspnea...

Critical Care Staffing in Pandemics The COVID-19 pandemic has had significant impact on healthcare, with millions of cases and deaths reported globally. Healthcare workers have been particularly affected, experiencing increased mental health issues, burnout, and moral distress. The pandemic has led to higher levels of anxiety, depression, stress reactions, sleep disturbances, and posttraumatic stress disorder among healthcare staff. Prolonged exposure to high-inten...

Teachable Moment  February 13, 2023 Time-Limited Trials of Intensive Care Unit Care John J. Popovich, Isadore Budnick, Thanh H. Neville JAMA Intern Med. 2023;183(4):360-361. doi:10.1001/jamainternmed.2022.6792 Story From the Front Lines Apatient in their 70s with pancreatic adenocarcinoma with known hepatic metastases and peritoneal carcinomatosis was admitted from the emergency department due to gastric outlet obstruction. Prior to admission, the p...

Artificial Intelligence-Generated Manuscripts The healthcare industry is seeing remarkable technological progress. Several new tools have emerged that could significantly influence scientific research. One notable tool is RTutor, which combines the R programming language with GPT-3. This integration allows users to create R code and conduct analyses using plain language explanations of data and desired procedures. This means that even without coding skills, users c...

EDITORIAL| VOLUME 164, ISSUE 4, P812-813, OCTOBER 2023 Fluid Therapy in Sepsis: Does It Matter How Much? Jonathan A. Silversides, Bram Rochwerg Chest 2023; 164: 812-813 DOI:https://doi.org/10.1016/j.chest.2023.05.027 Although IV fluid resuscitation is a fundamental element of sepsis management, debate regarding the ideal volume, type, timing, and physiologic targets is ongoing. A number of large randomized trials have been published addressing this importan...

Angiotensin II in Critically Ill Patients In December 2017, angiotensin II (ATII) intravenous infusion gained approval in the U.S. for treating septic or other distributive shock in adults. This approval was based on results from a phase II clinical trial which showed higher mean arterial pressure in septic shock patients on norepinephrine, who were randomly assigned to titrated ATII compared to placebo. However, the adoption and usage of ATII in clinical practice ...

EDITORIAL| VOLUME 164, ISSUE 4, P814-815, OCTOBER 2023 Lung-Protective Concept and Noninvasive Respiratory Support Masaaki Sakuraya Chest 2023; 164: 814-815 DOI:https://doi.org/10.1016/j.chest.2023.05.014 Noninvasive respiratory support (NIRS), which includes high-flow nasal cannula (HFNC) and noninvasive ventilation (NIV), has been used for initial respiratory treatment in patients with respiratory failure. However, conclusive evidence is insufficient for ...

Awake Prone Position in Acute Hypoxaemic Respiratory Failure A study aimed to improve understanding of the impact of the awake prone position on the breathing patterns of patients with low oxygen levels. The researchers carried out a crossover trial examining how awake prone position use in patients with acute hypoxaemic respiratory failure affected their physiological responses. The study involved 15 patients with acute hypoxaemic respiratory failure and PaO2/F...

Ultra-Low Tidal Volume Ventilation for COVID-19-ARDS A new study aimed to evaluate the effectiveness of ventilation with ultra-low tidal volume (ULTV) compared to low tidal volume (LTV) in patients suffering from COVID-19-related acute respiratory distress syndrome (ARDS). COVID-19-related ARDS is associated with a high mortality rate and extended mechanical ventilation duration.  The study was conducted in ten ICUs in France and included patients who were ...

Editorial  August 28, 2023 The Need for Randomized Clinical Trials Demonstrating Reduction in All-Cause Mortality With Blood Tests for Cancer Screening Sanket S. Dhruva, Rebecca Smith-Bindman, Rita F. Redberg JAMA Intern Med. 2023;183(10):1051-1053. doi:10.1001/jamainternmed.2023.3610 In recent years, blood tests that look for circulating tumor DNA and biomarkers (termed liquid biopsies) have been developed. As Carr and Welch describe in this issu...