Good morning! Welcome to another edition of Pressure Support, a weekly newsletter simplifying pulmonary and critical care medicine—and the systems that shape it.

Finished a week on pulmonary consults and got WORKED. This learning curve is near vertical.

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In this retrospective cohort of 3,096 people with cystic fibrosis and newly diagnosed ABPA, oral corticosteroid monotherapy was associated with an improved FEV1 trajectory, while adding an antifungal—or using an antifungal alone—did not improve lung function, time to pulmonary exacerbation, or relapse compared with steroids alone. While this observational study can’t settle treatment for every patient, it supports avoiding routine antifungal add-ons when the goal is better outcomes and instead being more deliberate about who truly needs them, which could reduce unnecessary medication exposure and complexity.

This piece notes that prolonged or continuous beta-lactam infusions keep antibiotic levels above target longer than intermittent dosing, and newer randomized evidence has pushed IDSA, SCCM, and ACCP to rate the mortality evidence as moderate in severely ill patients, while evidence for clinical cure remains low; the recommendation is still conditional and a loading dose is advised. From a PCCM workflow standpoint, this feels like a practical, relatively low-friction way to improve antibiotic exposure in the sickest patients, but implementation still depends on reliable loading doses, infusion logistics, and pharmacy/bedside coordination.

This PATH study found that total US vaping days rose 183% from 2013–14 to 2022–23, while daily vaping rose 230%. The biggest concern is that vaping days among people under 21 more than quadrupled, even as youth prevalence later declined, suggesting that people who keep vaping are doing it more often. I think tracking frequency—not just whether someone vaped in the past 30 days—is a much more useful way to understand nicotine exposure and should make public-health surveillance and counseling more actionable.

This article uses ten parables to explore how AI could reshape critical care through prognosis, monitoring, liability, research, clinical work, data governance, education, and triage, while emphasizing that the benefits, harms, and trade-offs remain uncertain rather than predictive. It asks clinicians, institutions, and regulators to decide what evidence, safeguards, and rules are needed before these tools become entrenched. The most useful move is to treat AI as a workflow and governance challenge—not just a technology upgrade—so we can improve efficiency without losing accountability, clinical judgment, privacy, or patient autonomy.

CRITICAL CARE
A patient with ARDS is receiving assisted pressure support. Airway pressures appear modest, but the esophageal tracing shows a ΔPes of 18 cm H₂O and a dynamic ΔPL of 22 cm H₂O.

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Keeping it simple,

Jared