Lung cancer remains the number 1 cause of cancer death in men and women in the United States and much of the world. This CHEST organization guideline examines the literature on primary treatment of patients with stage I and II non-small cell lung cancer (NSCLC) to provide evidence-based recommendations.

Successful procedural training is a universal concern for pulmonary and critical care medicine (PCCM) program directors. Bootcamps may provide a unique and often first opportunity for intense, immersive procedural learning without exposing patients to harm. New trainees must otherwise learn on the job while acclimating to unfamiliar environments and responsibilities. Our goal was to create a structured regional educational event conducted early in fellowship. We aspired to optimize familiarity with procedures and equipment, allay stress among trainees, and create a collaborative learning environment through sharing of simulation equipment and faculty among programs. This article outlines the design, implementation, and lessons learned from this 1-day, multidisciplinary PCCM and critical care medicine procedural bootcamp in the southwest region of the United States. The bootcamp program was designed as learner centered, with educational and experiential goals and feasibility in mind, using a flipped classroom model and testing to maximize time for psychomotor skills building. A multidisciplinary approach enriched the learning environment, modeled team-based procedural care, and fostered interprofessional collaboration. Assessments measured pre-knowledge and post-knowledge acquisition as well as gauged learner performance using checklists and small group interaction. Evaluation of feedback from learners, faculty, and participating programs allowed for yearly iterative improvements. We share these lessons learned as a model for other scalable and impactful medical education initiatives.

In 2012, the Global Lung Function Initiative (GLI) collected a large international database of spirometry measurements in healthy people from which predicted spirometric values were derived based on sex, age, and height for people from 4 different geographic ancestral groups. In 2023, a single set of predicted spirometry values was developed for the entire data set, designed to be independent of ancestry.

Lung cancer screening (LCS) has evolved over the past decade with research advances and clinical experience helping to define target populations for screening, improve lung nodule detection and management, and identify structural components of programs that improve the quality of screening delivery. The 2015 American College of Chest Physicians and American Thoracic Society policy statement "Components Necessary for High-Quality Lung Cancer Screening" identified 9 essential components for high-quality LCS. Ten years later, optimizing the balance between the benefits and harms of LCS and ensuring equitable screening among all population groups remain fundamental objectives. In this 2025 update, we aimed to summarize new knowledge and highlight critical components that are needed for providing high-quality LCS. A multidisciplinary group of LCS experts was assembled to review evidence from the past 10 years. The original components were reviewed and updated to develop 8 refined components that should be considered essential structural elements of screening programs. Each component recommended by the authors is supported by an evidence update. Applying this framework will allow screening programs across the country to ensure implementation of high-quality, net-benefit LCS.

Current indications for long-term oxygen therapy (LTOT) primarily are based on thresholds of arterial oxygen saturation (Sao2) or Pao2 that ignore fundamental mechanisms of adaptation and intolerance to hypoxia. In individuals exposed to chronic hypoxic conditions, the accumulation of hypoxia-inducible factors in the cell nucleus upregulates target genes that favor tolerance to hypoxia. Adaptations include hyperventilation, systemic vascular bed development, increased erythropoiesis, and cellular metabolic adjustments. Excessive responses to hypoxia also may develop, leading to pulmonary vasculature remodeling and other end-organ dysfunctions. Biomarkers of hypoxia may complement the measurement of Sao2 or Pao2 in personalizing oxygen prescription before end-organ dysfunction becomes clinically apparent.

The precise impact of cardiovascular risk factors (CVRFs) on the right ventricle-pulmonary circulation unit remains unclear.

With the sudden onset of the COVID-19 pandemic, countries rushed to implement guidelines for triage. Some were unprepared. In Germany, academic discourse had focused on criteria for triage, while often neglecting their translation into clinically applicable protocols in ICUs.

Pulmonary arteriovenous malformations (PAVMs) require therapeutic embolization and careful surveillance to prevent serious complications, including stroke, brain abscess, and hemoptysis. Although initial treatment guidelines are well established, posttreatment surveillance practices remain heterogeneous, with no standardized approach for monitoring treated lesions or detecting PAVM persistence. This variability in follow-up care may affect patient outcomes, particularly in high-risk populations such as those with hereditary hemorrhagic telangiectasia (HHT).

Pulmonary hypertension (PH) is a complex, life-threatening condition requiring noninvasive, accessible, and accurate diagnostic tools, particularly in resource-limited settings. Early and precise identification of PH and its subtypes is critical for effective management and timely intervention.

Increasing evidence supports lung cancer screening with low-dose CT (LDCT) imaging. However, the benefits of LDCT screening for lung cancer may not be immediate, making it unlikely to benefit patients with limited life expectancy.

Establishing the cause of a pleural effusion can be challenging. Analysis of pleural fluid (PF) is a powerful tool to determine the cause of a pleural effusion. Surprisingly, despite the diagnostic power of PF analysis (PFA), it is often underused. This review provides a practical framework to maximize the diagnostic potential of the PFA. We describe the role of a PFA in establishing the cause of a pleural effusion. We also discuss challenges and limitations of PFA.

A 54-year-old woman with a history of recurrent exertional dyspnea for 5 years was admitted for evaluation. Six months prior, she noted a worsening of her symptoms, with progressive physical activity limitation caused by exertional fatigue and dyspnea (climbing 2 to 3 flights of stairs). She also experienced palpitations, with an estimated heart rate that ranged from 120 to 150 beats per minute. The patient denied chest pain, hemoptysis, or other notable symptoms. Notably, the patient underwent surgical repair of an atrial septal defect more than 20 years earlier, with a good postoperative recovery. Regular postoperative echocardiograms revealed no residual shunt, no valvular abnormalities, and no pulmonary hypertension. The patient had no history of smoking, drug abuse, or alcohol consumption.