Perspectives on Using Race in Pulmonary Function Testing: A National Survey Fellows and Program Directors.

Background: Pulmonary function tests (PFTs) have historically used race-specific prediction equations. The recent American Thoracic Society guidelines recommend the use of a race-neutral approach in prediction equations. There are limited studies centering the opinions of practicing pulmonologists on the use of race in spirometry.

Spontaneous Pneumothorax in a Healthy Young Woman: Discussion About Treatment Options.

A spontaneous pneumothorax, a potentially life-threatening condition, is a disease process in which air enters the space between the visceral and parietal pleural of the lung, thus increasing the pressures in that space. It can be diagnosed by both physical exam and radiographic testing. In this case, we present a 21-year-old, otherwise healthy woman who presented with sudden, sharp shoulder pain and chest tightness and was diagnosed with her first, spontaneous pneumothorax.

Mechanical Thrombectomy for a Clot in Transit With Adherence to the Tricuspid Valve.

This case report investigates the management of a clot in transit (CIT), a rare but possibly life-threatening condition discovered in a small percentage of pulmonary embolism (PE) cases. CITs are thrombi lodged within the right-side heart chambers or the major veins, and there are currently no universal guidelines for their management though the literature has shown reduced mortality with reperfusion therapy compared to anticoagulation alone. In this case, a 96-year-old male who presented with a submassive PE was initially stabilized with anticoagulation and was then discovered to have a CIT with adherence to the tricuspid valve.

In-Hospital Cardiac Arrest Outcomes During the Early COVID-19 Pandemic in RI: A Qualitative Analysis.

Throughout the COVID-19 pandemic, there has been growing but limited data describing the poor mortality outcomes in COVID-19 patients who experienced In-Hospital Cardiac Arrest (IHCA). This study evaluated the baseline characteristics and outcomes of COVID-19 patients who underwent cardiopulmonary resuscitation (CPR) during hospitalization in the early phases of the pandemic and compared them to that of several national and international centers. A list of all the IHCA events in the Lifespan hospital network from March 2020 to April 2021 was generated, and data, including de-identified patient characteristics, comorbidities, and details of the IHCA event, were examined.

Baricitinib in hospitalised patients with COVID-19: A meta-analysis of randomised controlled trials.

Background: To date, only dexamethasone and tocilizumab have been shown to reduce mortality in patients with COVID-19. Baricitinib is a Janus kinase 1/2 inhibitor with known anti-inflammatory and anti-viral properties. We performed a meta-analysis of RCTs assessing the role of baricitinib in hospitalised patients with COVID-19.

Patient With Prior COVID-19 Infection Presenting With Acute Upper Airway Obstruction: A Case Report.

New clinical manifestations of coronavirus disease 2019 (COVID-19) have been emerging throughout the pandemic and are being reported to the medical community. There have been limited reports that the virus can cause acute airway compromise. Here, we describe a young patient with a recent COVID-19 infection now presenting with acute airway compromise, presumed to be pharyngitis, and their clinical course during their hospitalization.

Celiac Artery Compression Syndrome Presenting As Recurrent Diabetic Ketoacidosis: A Diagnostic Challenge.

Celiac artery compression syndrome (CACS), also known as median arcuate ligament syndrome, can sometimes represent a diagnostic challenge. Here, we present the case of a 29-year-old man who presented with recurrent diabetic ketoacidosis (DKA), abdominal pain, and vomiting thought to be due to cyclical vomiting syndrome. However, the lack of a clear precipitant for DKA, the presence of chronic gastrointestinal symptoms, and a revealing physical examination of abdominal bruit led to clinical suspicion of CACS and its diagnosis after appropriate investigations.

Causes of an elevated international normalized ratio in the intensive care unit and the implications for plasma transfusion.

Background: The presence of an elevated international normalized ratio (INR) is common in patients in the intensive care unit (ICU), but the cause rarely determined. These patients are at risk to receive prophylactic plasma prior to invasive procedures.

Study Design And Methods: Samples from patients with an INR of 1.

A Case of Interstitial Pneumonia with Features of Autoimmunity.

We present a case of a 61-year-old woman with several months of gradually worsening shortness of breath, requiring multiple hospitalizations with acute hypoxemic respiratory failure. She was initially treated for eosinophilic pneumonia presumed to be secondary to medications or rheumatoid lung without much improvement. Her subsequent chest CT showed honeycombing and diffuse ground-glass opacities, and she was found to have elevated rheumatoid factor (RF) and anti-CCP antibody titers without extrathoracic features of rheumatoid arthritis.

A Rare Case of 4 Ps: Bilateral Pneumothoraces and Pneumomediastinum in Pneumocystis Pneumonia.

We report a case of Pneumocystis jirovecii pneumonia (PCP) complicated by bilateral pneumothoraces and pneumomediastinum in a non-human immunodeficiency virus (HIV)- infected patient. This unusual presentation exemplifies the differences in clinical course and presentation in non-HIV versus HIV-infected individuals, and the poor prognosis associated with PCP complicated by pneumothorax or pneumomediastinum. Providers should be aware of the high mortality in patients who develop one, and especially both complications.

Intensive care unit rounding checklists to reduce catheter-associated urinary tract infections.

Objective: To assess whether the implementation of an intensive care unit (ICU) rounding checklist reduces the number of catheter-associated urinary tract infections (CAUTIs).

Design: Retrospective before-and-after study that took place between March 2013 and February 2017.

Setting: An academic community hospital 16-bed, mixed surgical, cardiac, medical ICU.

A Case of Vaping-Associated Lung Injury in Rhode Island.

The Centers for Disease Control and Prevention (CDC) is currently investigating a nationwide outbreak of e- cigarette, or vaping, associated lung injury (EVALI). The objective of this case report is to review a suspected case of EVALI in Rhode Island and discuss how to identify and manage this condition.

Red Blood Cell Transfusions in the ICU.

Red blood cells are commonly administered to critically ill patients, yet the desired benefit of improving oxygen delivery and overall outcome may not be achieved in many scenarios. In addition, blood products are of limited supply and there are clear risks associated with blood transfusion. Despite this, studies show that almost half of all ICU patients receiving blood transfusions do so in the setting of stable anemia, suggesting that many critically ill patients in the ICU may receive unnecessary transfusions.

The impact of errors on healthcare professionals in the critical care setting.

Purpose: Medical errors occur at high rates in intensive care units (ICUs) and have great consequences. The impact of errors on healthcare professionals is rarely discussed. We hypothesized that issues regarding blame and guilt following errors in the ICU exist and may be dependent on type of practitioner, level of experience, and error type.

A case of legionella pneumonia caused by home use of continuous positive airway pressure.

A 67-year-old woman with morbid obesity and severe obstructive sleep apnea presented to the emergency department with 2 days of productive cough, fever, shortness of breath and loose stools. A chest x-ray showed extensive bilateral infiltrates, and she was quickly intubated for acute hypoxic respiratory failure. A urine legionella antigen test was positive, and she was admitted to the intensive care unit with a diagnosis of severe legionella pneumonia.

Cardiogenic shock from coronary vasculitis in granulomatosis with polyangiitis.

Granulomatosis with polyangiitis (GPA) is a systemic vasculitis characterised by necrotising inflammatory changes in small-sized and medium-sized vessels and granuloma formation. It most commonly involves the kidneys and respiratory tract, but it can present with widespread manifestations involving any organ system. Rarely, it causes coronary vasculitis which can precipitate a severe cardiomyopathy.

Lithium toxicity after Roux-en-Y bariatric surgery.

A 61-year-old woman with medical history significant for morbid obesity, type II diabetes mellitus, nephrogenic diabetes insipidus and bipolar disorder, had been stable on lithium carbonate therapy for several years. She had undergone a Roux-en-Y bypass surgery and, at the time of her surgery, her lithium level was found to be 0.61 mEq/L on a maintenance dose of 600 mg orally twice per day.

Arterial Catheter Use in the ICU: A National Survey of Antiseptic Technique and Perceived Infectious Risk.

Objectives: Recent studies have shown that the occurrence rate of bloodstream infections associated with arterial catheters is 0.9-3.4/1,000 catheter-days, which is comparable to that of central venous catheters.

Maternal mortality secondary to acute respiratory failure in Colombia: a population-based analysis.

Purpose: To estimate the mortality rate and trends of respiratory failure in the pregnant and postpartum population of Colombia.

Methods: A retrospective analysis of the national registry of mortality in Colombia was performed from 1998 to 2009. Maternal death was defined as death that occurred during pregnancy or up to 42 days postpartum.

Insertion and use of arterial catheters: a survey of clinician antiseptic technique.

Rationale: Recent studies have shown that the incidence of bloodstream infections (BSIs) associated with arterial catheters (ACs) is comparable to that of central venous catheters (CVCs). In 2011, the CDC published guidelines recommending the use of limited barrier precautions during AC insertion. The goal of this study was to assess the attitudes and current antiseptic techniques employed by physicians who place arterial catheters in intensive care units.

A prophylactic fresh frozen plasma transfusion leads to a possible case of transfusion-related acute lung injury.

A 39-year-old man with cholangiocarcinoma presented with fever and abdominal pain. He was hypotensive, jaundiced and had right upper quadrant tenderness. Laboratory testing showed a leucocytosis, elevated liver function tests, total bilirubin and International Normalised Ratio (INR).

Inhaled β-agonist therapy and respiratory muscle fatigue as under-recognised causes of lactic acidosis.

A 49-year-old man with chronic obstructive pulmonary disease (COPD) presented with significant tachypnoea, fevers, productive cough and increased work of breathing for the previous 4 days. Laboratory data showed elevated lactate of 3.2 mEq/L.

Massive intravascular hemolysis from Clostridium perfringens septicemia: a review.

We describe the case of a patient with hemolysis-associated Clostridium perfringens septicemia and review all similar cases published in the literature since 1990, with specific focus on the relationship between treatment strategy and survival. We searched PubMed for all published cases of C. perfringens-associated hemolysis, using the medical subject terms "clostridia," "clostridial sepsis," and/or "hemolysis.