A 62-year-old man with metastatic melanoma is admitted to the ICU for acute respiratory failure requiring mechanical ventilation (assist-control mode, FiO2 0.8). He reports 48 hours of progressive dyspnea and a nonproductive cough. His PaO2/FiO2 ratio is 150. Three weeks ago he began pembrolizumab 200 mg IV every 3 weeks. His home medications are lisinopril and metformin. Chest CT shows new, bilateral diffuse ground-glass opacities with reticular infiltrates. An extensive infectious workup (sputum and blood cultures, viral panel) is negative, and echocardiogram demonstrates normal left ventricular function. Which of the following is the most likely cause of his acute pulmonary deterioration?

A 68-year-old man was admitted 3 weeks ago for ventricular tachycardia and started on amiodarone 400 mg daily. Over the past 72 hours, he has developed progressive dyspnea, a persistent nonproductive cough, and increased oxygen requirements. Vital signs are: temperature 37.8 °C, blood pressure 130/80 mm Hg, heart rate 90 bpm, respiratory rate 24 breaths/min, and oxygen saturation 88% on 4 L/min nasal cannula. Arterial blood gas on 4 L/min shows pH 7.43, PaO2 60 mm Hg, PaCO2 40 mm Hg. On exam he is tachypneic with fine bibasilar crackles, no jugular venous distension, and no peripheral edema. A recent chest CT reveals new bilateral ground-glass opacities and diffuse interstitial infiltrates. Bronchoalveolar lavage and sputum cultures are negative for bacterial, fungal, and viral pathogens. A transthoracic echocardiogram performed one week ago showed stable left ventricular ejection fraction of 55% and no signs of fluid overload. Considering the clinical presentation, imaging findings, and negative infectious and cardiac workup, which of the following is the most appropriate next diagnostic and management step?

A 62-year-old man with metastatic melanoma received his last dose of pembrolizumab 2 weeks ago and now presents with acute hypoxemic respiratory failure. He is intubated and ventilated in assist-control mode with a tidal volume of 6 mL/kg predicted body weight, respiratory rate 20 breaths/min, FiO₂ 0.80, PEEP 10 cm H₂O, and PaO₂/FiO₂ ratio of 120 (moderate ARDS). Chest CT shows new bilateral ground-glass opacities and reticular changes predominantly in the lower lobes. White blood cell count is 9,800/mm³, procalcitonin is 0.1 ng/mL, blood cultures are negative, and echocardiogram reveals normal cardiac function. His respiratory status has worsened over 48 hours despite broad-spectrum antibiotics. Given suspected immune checkpoint inhibitor–induced pneumonitis, what is the most critical initial management step?

A 62-year-old female patient (weight 70 kg) is admitted to the intensive care unit, currently intubated and on assist-control ventilation with a PEEP of 10 cm H₂O for acute hypoxemic respiratory failure. She has a central venous catheter in place for vasopressor support. Chest CT reveals new, diffuse ground-glass opacities and reticular changes consistent with an organizing pneumonia pattern. She was started on amiodarone 3 weeks ago for atrial fibrillation. Infectious workup, including sputum cultures and viral panels, is negative. Her oxygen saturation is 88% on FiO₂ 0.8 despite increasing ventilatory support. Suspected diagnosis is severe drug-induced lung disease (DILD). Considering her clinical presentation and the suspected diagnosis of severe DILD, which of the following represents the MOST appropriate initial pharmacological management strategy?

A 65-year-old man with a history of hypertension is admitted to the critical care unit, currently intubated and on assist-control ventilation for acute hypoxic respiratory failure. He has a central line for vasopressor support. Six months prior, he was started on amiodarone for new-onset atrial fibrillation. His chest CT shows diffuse interstitial infiltrates. Infectious workup, including sputum cultures and viral panels, has been negative. Bronchoalveolar lavage shows lymphocytic alveolitis, highly suggestive of drug-induced lung injury (DILD), classified as Grade 3 due to the need for mechanical ventilation. He is currently receiving high-dose intravenous corticosteroids. Given this patient’s presentation and confirmed diagnosis of Grade 3 DILD, which of the following long-term management strategies represents the highest priority to ensure optimal recovery and prevent recurrence?

A 62-year-old man with metastatic melanoma, recently initiated on an immune checkpoint inhibitor, was admitted to the critical care unit for acute hypoxic respiratory failure secondary to suspected drug-induced pneumonitis. He required mechanical ventilation and was started on high-dose methylprednisolone 2 mg/kg/day (160 mg/day for his 80 kg weight). Over the past 7 days, he has shown significant clinical improvement, was successfully extubated, and is now on 2 L/min nasal cannula with SpO₂ 96%. His chest CT from yesterday shows significant resolution of the previously noted ground-glass opacities and consolidations. The medical team is planning transfer out of the critical care unit and initiation of a steroid taper. Given the patient’s clinical course and the need to prevent recurrence of drug-induced lung disease, which of the following is the MOST critical aspect in the ongoing management plan?

A 62-year-old man weighing 70 kg is admitted to the ICU for severe drug-induced lung disease (DILD). He was initially placed on mechanical ventilation and received high-dose corticosteroids at 2 mg/kg/day (140 mg/day) for Grade 3 pneumonitis, suspected to be caused by amiodarone, which was immediately discontinued upon admission. His respiratory status has improved, and he is now extubated and on high-flow nasal cannula. The patient is being prepared for transfer to a general medical floor. Considering this patient’s recovery from severe DILD, which of the following is the MOST crucial action to prioritize to prevent recurrence of this adverse drug reaction?