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Lung transplant, intensive care

Mohamed Omara, Toshihiro Okamoto, Amr Arafat, Lucy Thuita, Eugene H Blackstone, Kenneth R McCurry
BACKGROUND: Patients who have undergone prior cardiothoracic procedures offer technical challenges that may affect post-transplant outcomes and be a reason to decline listing. Data are currently limited regarding the indication for lung transplantation among recipients who have had prior cardiothoracic procedures. METHODS: Of 453 lung transplants performed at Cleveland Clinic from January 2005 to July 2010, 206 recipients (45%) had undergone prior cardiothoracic procedures: 157 lung only, 15 cardiac only, 10 cardiac + lung, 10 pleurodesis + lung, and 14 other...
June 14, 2016: Journal of Heart and Lung Transplantation
L Sakhri, C Saint-Raymond, S Quetant, C Pison, E Lagrange, R Hamidfar Roy, J-P Janssens, C Maindet-Dominici, M Garrouste-Orgeas, M Levy-Soussan, N Terzi, A-C Toffart
The issue of intensive and palliative care in patients with chronic disease frequently arises. This review aims to describe the prognostic factors of chronic respiratory diseases in stable and in acute situations in order to improve the management of these complex situations. The various laws on patients' rights provide a legal framework and define the concept of unreasonable obstinacy. For patients with chronic obstructive pulmonary disease, the most robust decision factors are good knowledge of the respiratory disease, the comorbidities, the history of previous exacerbations and patient preferences...
September 14, 2016: Revue des Maladies Respiratoires
Seokkee Lee, Hyo Chae Paik, Seok Jin Haam, Chang Young Lee, Kyung Sik Nam, Hee Suk Jung, Young Woo Do, Jee Won Shu, Jin Gu Lee
BACKGROUND: In lung transplantation (LTx), patients with thoracic muscle sarcopenia may have to require longer to recovery. We measured thoracic muscle volume by using the cross sectional area (CSA) and assessed its effect on early outcomes after LTx. METHODS: A retrospective analysis was conducted to evaluate the effect of thoracic sarcopenia in patients undergoing LTx between January 2010 and July 2015. The lowest CSA quartile (Q1) was defined as sarcopenia. RESULTS: In total, 109 patients were enrolled...
August 2016: Journal of Thoracic Disease
Micah A Skeens, Jennifer McArthur, Ira M Cheifetz, Christine Duncan, Adrienne G Randolph, Joseph Stanek, Leslie Lehman, Rajinder Bajwa
Veno-occlusive disease (VOD) is a potentially fatal complication of hematopoietic stem cell transplantation (HSCT). Patients with VOD are often critically ill and require close collaboration between transplant physicians and intensivists. We surveyed members of a consortium of pediatric intensive care unit (PICU) and transplant physicians to assess variability in the self-reported approach to the diagnosis and management of VOD. An internet-based self-administered survey was sent to pediatric HSCT and PICU providers from September 2014 to February 2015...
October 2016: Biology of Blood and Marrow Transplantation
Aaron C Spicer, Carolyn S Calfee, Matthew S Zinter, Robinder G Khemani, Victoria P Lo, Mustafa F Alkhouli, Benjamin E Orwoll, Ana L Graciano, Juan P Boriosi, James P Howard, Heidi R Flori, Michael A Matthay, Anil Sapru
OBJECTIVES: Despite declining mortality, acute respiratory distress syndrome is still involved in up to one third of pediatric intensive care deaths. The recently convened Pediatric Acute Lung Injury Consensus Conference has outlined research priorities for the field, which include the need for accurate bedside risk stratification of patients. We aimed to develop a simple yet robust model of mortality risk among pediatric patients with acute respiratory distress syndrome to facilitate the targeted application of high-risk investigational therapies and stratification for enrollment in clinical trials...
October 2016: Pediatric Critical Care Medicine
J W Awori Hayanga, Jonathan K Aboagye, Heather K Hayanga, James D Luketich, Jonathan D'Cunha
BACKGROUND: In this study we sought to determine survival rates after use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung re-transplantation (re-LT). METHODS: Propensity-adjusted analysis was performed on data from the Scientific Registry of Transplant Recipients (SRTR) to evaluate survival in recipients between the years 1988 and 2012, based on the use of ECMO before re-LT. RESULTS: A total of 854 adult re-LT recipients were identified...
July 2016: Journal of Heart and Lung Transplantation
Su Hyun Lee, Jin Gu Lee, Chang Yeong Lee, Namo Kim, Min-Yung Chang, Young-Chul You, Hyun Joo Kim, Hyo Chae Paik, Young Jun Oh
DESIGN: Inhaled iloprost was known to alleviate ischemic-reperfusion lung injury. We investigated whether intraoperative inhaled iloprost can prevent the development of primary graft dysfunction after lung transplantation. Data for a consecutive series of patients who underwent lung transplantation with extracorporeal membrane oxygenation were retrieved. By propensity score matching, 2 comparable groups of 30 patients were obtained: patients who inhaled iloprost immediately after reperfusion of the grafted lung (ILO group); patients who did not receive iloprost (non-ILO group)...
July 2016: Medicine (Baltimore)
Andreas Wallinder, Gerdt C Riise, Sven-Erik Ricksten, Martin Silverborn, Göran Dellgren
BACKGROUND: A large proportion of donor lungs are discarded due to known or presumed organ dysfunction. Ex vivo lung perfusion (EVLP) has proven its value as a tool for discrimination between reversible and irreversible donor lung pathology. However, the long-term outcome after transplantation of lungs after EVLP is essentially unknown. We report short-term and midterm outcomes of recipients who received transplants of EVLP-evaluated lungs. METHODS: Single-center results of recipients of lungs with prior EVLP were compared with consecutive recipients of non-EVLP lungs (controls) during the same period...
May 31, 2016: Journal of Heart and Lung Transplantation
J W Awori Hayanga, Jonathan K Aboagye, Norihisa Shigemura, Heather K Hayanga, Edward Murphy, Asghar Khaghani, Jonathan D'Cunha
BACKGROUND: Airway complications are rare and cause increased morbidity and mortality after lung transplantation (LT). We sought to examine risk factors associated with this complication and its impact on survival. METHODS: We retrospectively evaluated United Network for Organ Sharing data from 2000 to 2012. A backward stepwise logistic regression was performed on recipient-, donor-, and transplant-related variables to select independent risk factors associated with airway complications and mortality...
May 6, 2016: Journal of Heart and Lung Transplantation
Daniel J Lebovitz, Matthew Tabbut, Samir Q Latifi, Lynn Dezelon, Robert Jones
CONTEXT: Lung transplantation is limited by donor lung availability with ∼20% of deceased donor lungs transplanted. Diagnostic testing identifying pulmonary derangements guide donor management strategies to maximize lung transplantation. Lung ultrasound (LUS) identifies pathology in critically ill patients equivalent or superior to chest radiograph (CXR) or computed tomography (CT) scans. No published studies have reported on LUS in neurologically deceased donors (DNDDs). OBJECTIVE: We evaluated LUS in identifying abnormal lung pathology in DNDDs and related these findings to the standard approach...
September 2016: Progress in Transplantation
Marijan Koprivanac, Marie M Budev, James J Yun, Marta Kelava, Gösta B Pettersson, Kenneth R McCurry, Douglas R Johnston, Abeel A Mangi, Penny L Houghtaling, Eugene H Blackstone, Sudish C Murthy
BACKGROUND: Coronary artery disease (CAD) remains a relative contraindication for lung transplantation, but should it be if amenable to effective palliation? METHODS: From January 2005 to July 2010, 356 adults undergoing primary lung transplantation had no significant (<50%) coronary arterial stenosis and 70 had significant (≥50%) CAD requiring prior or concomitant revascularization. Propensity matching on 38 pre-transplant patient characteristics identified 61 well-matched pairs (87% of possible matches) and 295 no-CAD unmatched patients to compare post-operative morbidity, graft function, and time-related pulmonary function and survival...
March 30, 2016: Journal of Heart and Lung Transplantation
Joseph Costa, Sowmyashree Sreekanth, Alex Kossar, Kashif Raza, David J Lederer, Hilary Robbins, Lori Shah, Joshua R Sonett, Selim Arcasoy, Frank D'Ovidio
OBJECTIVES: Standard donor lung assessment relies on imaging, challenge gases and subjective interpretation of bronchoscopic findings, palpation and visual assessment. Central gases may not accurately represent true quality of the lungs. We report our experience using selective pulmonary vein gases to corroborate the subjective judgement. METHODS: Starting, January 2012, donor lungs have been assessed by intraoperative bronchoscopy, palpation and visual judgement of lung collapse upon temporary disconnection from ventilator, central gases from the aorta and selective pulmonary vein gases...
May 30, 2016: European Journal of Cardio-thoracic Surgery
Bárbara Balandin, Miriam Aguilar, Isabel Sánchez, Araceli Monzón, Isabel Rivera, Clara Salas, Miguel Valdivia, Sara Alcántara, Aris Pérez, Piedad Ussetti
Infections due Scedosporium spp. in lung transplant recipients are associated with disseminated disease with high mortality rates. The adjunctive local antifungal therapy may be a useful option when systemic treatment is insufficient and/or surgery is not feasible. We present a case of mixed disseminated infection due Scedosporium apiospermum and S. prolificans in a lung transplant recipient. Combined local and systemic antifungal therapy provided an unusual long-term survival in the intensive care unit.
March 2016: Medical Mycology Case Reports
M-L Felten, J-D Moyer, J-F Dreyfus, J-Y Marandon, E Sage, A Roux, F Parquin, C Cerf, B Zuber, M Le Guen, M Fischler
BACKGROUND: We reviewed our experience with tracheal extubation in the operating room (E-OR) among cystic fibrosis patients requiring bilateral lung transplantation to evaluate safety and determine predictive factors of E-OR. METHODS: The charts of 89 recipients (from May 2007 to June 2013) were analysed. Patients were divided into E-OR and E-ICU (intensive care unit extubation) groups. Data are expressed as numbers (percentages) or medians [25th-75th percentiles]...
June 2016: British Journal of Anaesthesia
R A F M Chamuleau
In 2016, an intensive-care physician has at his disposal a number of artificial organs for the support of patients with organ failure. Examples are the artificial kidney and the heart-lung machine. Artificial livers are being developed for patients with severe liver failure whose lives can only be saved at the present time by a transplant with a donor liver. These artificial livers are based either on a device that removes toxic materials from the patient's blood with, for example, albumin dialysis, or make use of bio-reactors filled with functioning liver cells, the so-called bio-artificial liver...
May 2016: Nederlands Tijdschrift Voor Tandheelkunde
Adam Sieg, Phillip Weeks, Lori Krustchinsky, Indranee Rajapreyar
Cardiac allograft vasculopathy (CAV) is a unique multi-factorial pathologic process encountered following heart transplantation. Several risk factors have been identified including a combination of immunologic and non-immunologic processes. Significant research has been conducted to elucidate the driving forces of CAV as well as improved identification, prevention and treatment strategies. Statin therapy following transplant remains the standard of care to help prevent the progression of CAV. The benefits of statin therapy following transplantation correspond to cholesterol control, anti-inflammatory and immunomodulatory mechanisms as well as potentially unknown mechanisms...
July 2016: Transplantation Reviews
Georg Hansmann, Christian Apitz, Hashim Abdul-Khaliq, Tero-Pekka Alastalo, Phillip Beerbaum, Damien Bonnet, Karl-Otto Dubowy, Matthias Gorenflo, Alfred Hager, Anne Hilgendorff, Michael Kaestner, Martin Koestenberger, Juha W Koskenvuo, Rainer Kozlik-Feldmann, Titus Kuehne, Astrid E Lammers, Heiner Latus, Ina Michel-Behnke, Oliver Miera, Shahin Moledina, Vivek Muthurangu, Joseph Pattathu, Dietmar Schranz, Gregor Warnecke, Peter Zartner
UNLABELLED: : The European Paediatric Pulmonary Vascular Disease (PVD) Network is a registered, non-profit organisation that strives to define and develop effective, innovative diagnostic methods and treatment options in all forms of paediatric pulmonary hypertensive vascular disease, including specific forms such as pulmonary arterial hypertension (PAH)-congenital heart disease, pulmonary hypertension (PH) associated with bronchopulmonary dysplasia, persistent PH of the newborn, and related cardiac dysfunction...
May 2016: Heart: Official Journal of the British Cardiac Society
Michael Kaestner, Dietmar Schranz, Gregor Warnecke, Christian Apitz, Georg Hansmann, Oliver Miera
Acute pulmonary hypertension (PH) complicates the course of several cardiovascular, pulmonary and other systemic diseases in children. An acute rise of RV afterload, either as exacerbating chronic PH of different aetiologies (eg, idiopathic pulmonary arterial hypertension (PAH), chronic lung or congenital heart disease), or pulmonary hypertensive crisis after corrective surgery for congenital heart disease, may lead to severe circulatory compromise. Only few clinical studies provide evidence on how to best treat children with acute severe PH and decompensated RV function, that is, acute RV failure...
May 2016: Heart: Official Journal of the British Cardiac Society
Tülin Akarsu Ayazoğlu, Aynur Ozensoy, Mehmet Dedemoğlu, Ayse Baysal, Yasar G Gul, Didem Onk, Alper Onk
AIM: The aim of this study is to present our institutional experience during the management of anesthesia in lung transplantation (LT) surgeries as a definitive surgical treatment option in end-stage lung diseases. METHODS: From a total of 15 patients, lung transplantation was performed as single LT (SLT) in 4 patients (n = 4) and as sequential bilateral LT (BLT) in 11 patients (n = 11). The anesthetic management included; for induction; intravenous ketamine, midazolam at doses of 2 mg/kg, 0...
April 2016: Archives of Iranian Medicine
Mariya A Geube, Silvia E Perez-Protto, Tory L McGrath, Dongsheng Yang, Daniel I Sessler, Marie M Budev, Andrea Kurz, Kenneth R McCurry, Andra E Duncan
BACKGROUND: Severe primary graft dysfunction (PGD) is a major cause of early morbidity and mortality in patients after lung transplantation. The etiology and pathophysiology of PGD is not fully characterized and whether intraoperative fluid administration increases the risk for PGD remains unclear from previous studies. Therefore, we tested the hypothesis that increased total intraoperative fluid volume during lung transplantation is associated with the development of grade-3 PGD. METHODS: This retrospective cohort analysis included patients who had lung transplantation at the Cleveland Clinic between January 2009 and June 2013...
April 2016: Anesthesia and Analgesia
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