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To determine the 30- and 90-day outcomes of COVID-19 patients receiving tracheostomy and percutaneous endoscopic gastrostomy (PEG).Retrospective observational study.Multisite, inpatient.Hospitalized COVID-19 patients who received tracheostomy and PEG at four Boston hospitals.Tracheostomy and PEG placement.The primary outcome was mortality at 30 and 90 days post-procedure. Secondary outcomes included continued device presence, place of residence, complications, and rehospitalizations. Eighty-one COVID-19 patients with tracheostomy and PEG placement were included. At 90 days post-device placement, the mortality rate was 9.9%, 2.7% still had the tracheostomy, 32.9% still had the PEG, and 58.9% were at home.More than nine-in-10 patients in our population of COVID-19 patients who underwent tracheostomy and PEG were alive 90 days later and most were living at home. This study provides new information regarding the outcomes of this patient population that may serve as a step in guiding clinicians, patients, and families when making decisions regarding these devices.

The U.S. transplant community is debating an approach to reducing geographic disparities in organ distribution: redrawing the liver-allocation map to reduce disparities among patients with similar disease severity, without increasing deaths on the waiting list.

Rationale: Idiopathic pulmonary fibrosis is often initially misdiagnosed. Delays in accessing subspecialty care could lead to worse outcomes among those with idiopathic pulmonary fibrosis. Objectives: To examine the association between delayed access to subspecialty care and survival time in idiopathic pulmonary fibrosis. Methods: We performed a prospective cohort study of 129 adults who met American Thoracic Society criteria for idiopathic pulmonary fibrosis evaluated at a tertiary care center. Delay was defined as the time from the onset of dyspnea to the date of initial evaluation at a tertiary care center. We used competing risk survival methods to examine survival time and time to transplantation. Measurements and Main Results: The mean age was 63 years and 76% were men. The median delay was 2.2 years (interquartile range 1.0–3.8 yr), and the median follow-up time was 1.1 years. Age and lung function at the time of evaluation did not vary by delay. A longer delay was associated with an increased risk of death independent of age, sex, forced vital capacity, third-party payer, and educational attainment (adjusted hazard ratio per doubling of delay was 1.3, 95% confidence interval 1.03 to 1.6). Longer delay was not associated with a lower likelihood of undergoing lung transplantation. Conclusions: Delayed access to a tertiary care center is associated with a higher mortality rate in idiopathic pulmonary fibrosis independent of disease severity. Early referral to a specialty center should be considered for those with known or suspected interstitial lung disease.

Early in my intern year, I admitted an 80-year-old man with pneumonia to the intensive care unit (ICU). He had hypotension and was struggling to breathe, and my senior resident and I told his family that it was touch and go. Their response: Do everything. He had repaired cars for a living, and he was a tough guy, a fighter. Ten days later, his condition had stabilized, but he was delirious and unable to breathe on his own. We told his family that if we were to continue, he'd need a tracheotomy and feeding tube. They agreed without question. We . . .

Whereas effective treatment for noncommunicable diseases may be too costly to disseminate globally, opioids for pain control are cheap to produce. Yet 80% of the population, including millions of patients with terminal cancer, lacks adequate access to pain treatment.

The way I remember it now, I spent much of my medical internship doing things to people—uncomfortable, even unnecessary things—at odd hours to seem thorough on rounds.