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The promise of artificial intelligence has generated enthusiasm among patients, health care professionals, and technology developers who seek to leverage its potential to enhance the diagnosis and management of an increasing number of chronic and acute conditions. Point-of-care testing increases access to care because it enables care outside of traditional medical settings. Collaboration among developers, clinicians, and end users is an effective best practice for solving clinical problems. A common set of clearly defined terms that are easily understood by research teams is a valuable tool that fosters these collaborations.

Topic importance: This narrative review emphasizes the growing interest in palliative care for people with serious lung diseases such as COPD. It reflects on recent publications from the American Thoracic Society, the World Health Organization, and European Respiratory Society, with a focus on nonpharmacologic palliative care for people with COPD from both the health care professional and organizational perspective.

Review findings: The concept of palliative care has changed over time and is now seen as applicable throughout the entire disease trajectory according to need, in conjunction with any disease-modifying therapies. Palliative care should pay attention to the needs of the person with COPD as well as the informal caregiver. Timely integration of palliative care with disease-modifying treatment requires assessment of needs at the individual level as well as organizational changes. High-quality communication, including advance care planning, is a cornerstone of palliative care.

Summary: Therefore, services should be based on the understanding that palliative care is not only specific standardized actions and treatments, but rather a holistic approach that includes compassionate communication, treatment, and care addressing the patient and informal and formal caregivers. Living with and dying of COPD is much more than objective measurements. It is the sum of relationships with others and the experience of living in the best possible harmony with one's own values and hopes, despite having a serious illness.

Case presentation: 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.

Background: To our knowledge, no large observational study has compared the incidence and risk factors for extubation failure within 48 h and during ICU stay in the same cohort of unselected critically ill patients with and without obesity.

Research question: What are the incidence and risk factors of extubation failure in patients with and without obesity?

Study design and methods: In the prospective multicenter observational Practices and Risk Factors for Weaning and Extubation Airway Failure in Adult Intensive Care Unit: A Multicenter Trial (FREEREA) study in 26 ICUs, the primary objective was to compare the incidence of extubation failure within 48 h in patients with and without obesity. Secondary objectives were to describe and to identify the independent specific risk factors for extubation failure using first a logistic regression model and second a decision tree analysis.

Results: Of 1,370 extubation procedures analyzed, 288 (21%) were performed in patients with obesity and 1,082 (79%) in patients without obesity. The incidence of extubation failure within 48 h among patients with or without obesity was 23 of 288 (8.0%) vs 118 of 1,082 (11%), respectively (unadjusted OR, 0.71; 95% CI, 0.45-1.13; P = .15); alongside patients with obesity receiving significantly more noninvasive ventilation [87 of 288 (30%) vs 233 of 1,082 (22%); P = .002] and physiotherapy [165 of 288 (57%) vs 527 of 1,082 (49%); P = .02] than patients without obesity. Risk factors for extubation failure also differed according to obesity status: female sex (adjusted OR, 4.88; 95% CI, 1.61-13.9; P = .002) and agitation before extubation (adjusted OR, 6.39; 95% CI, 1.91-19.8; P = .001) in patients with obesity, and absence of strong cough before extubation (adjusted OR, 2.38; 95% CI, 1.53-3.84; P = .0002) and duration of invasive mechanical ventilation before extubation (adjusted OR, 1.03/d; 95% CI, 1.01-1.06; P = .01) in patients without obesity. The decision tree analysis found similar risk factors.

Interpretation: Our findings indicate that anticipation and application of preventive measures for patients with obesity before and after extubation led to similar rates of extubation failure among patients with and without obesity.

Clinical trial registration: ClinicalTrials.gov; No.: NCT02450669; URL: www.

Clinicaltrials: gov.

Case presentation: 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.