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A Piece of My Mind
August 20, 2019

A Tale of Two Lungs

Author Affiliations
  • 1Department of Internal Medicine, University of Michigan, Ann Arbor
JAMA. 2019;322(7):613-614. doi:10.1001/jama.2019.11287

Intensive care unit rounds started that morning with a man in his 50s with end-stage lung disease, being evaluated for transplant, who was admitted for an acute exacerbation of chronic respiratory failure. He was doing relatively well after admission until the early afternoon when pulse oximetry readings slowly decreased and work of breathing increased. His respiratory rate increased to higher than 50 and heart rate up to the 140s as pulse oximetry readings decreased to 80% with any movement. He was constantly coughing, unable to speak in full sentences, confined to bed in a seated position. He told the admitting team he did not want resuscitation and would only want intubation if it was elective.

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