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Martínez-Martínez M, Schmidt M, Broman LM, Roncon-Albuquerque R, Langouet E, Campos I, Argudo E, Domènech Vila JM, Sastre SM, Gallart E, Ferrer R, Combes A, Riera J. Survival and Long-Term Functional Status of COVID-19 Patients Requiring Prolonged Extracorporeal Membrane Oxygenation Support. Ann Am Thorac Soc 2024; 21:449-455. [PMID: 38134435 PMCID: PMC10913764 DOI: 10.1513/annalsats.202306-572oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023] Open
Abstract
Rationale: Severe cases of acute respiratory distress syndrome (ARDS) may require prolonged (>28 d) extracorporeal membrane oxygenation (ECMO). In nonresolving disease, recovery is uncertain, and lung transplant may be proposed. Objectives: This study aims to identify the variables influencing survival and to describe the functional status of these patients at 6 months. Methods: This was a retrospective, multicenter, observational cohort study including patients requiring ECMO support for coronavirus disease (COVID-19)-related ARDS for >28 days. Multivariate analysis was performed using Cox regression in preselected variables and in least absolute shrinkage and selection operator selected variables. In a post hoc analysis to account for confounders and differences in awake strategy use by centers, treatment effects of the awake strategy were estimated using an augmented inverse probability weighting estimator with robust standard errors clustered by center. Results: Between March 15, 2020 and March 15, 2021, 120 patients required ECMO for >28 days. Sixty-four patients (53.3%) survived decannulation, 62 (51.7%) were alive at hospital discharge, and 61 (50.8%) were alive at 6-month follow-up. In the multivariate analysis, age (1.09; 95% confidence interval [CI], 1.03-1.15; P = 0.002) and an awake ECMO strategy (defined as the patient being awake, cooperative, and performing rehabilitation and physiotherapy with or without invasive mechanical ventilation at any time during the extracorporeal support) (0.14; 95% CI, 0.03-0.47; P = 0.003) were found to be predictors of hospital survival. At 6 months, 51 (42.5%) patients were at home, 42 (84.3%) of them without oxygen therapy. A cutoff point of 47 ECMO days had a 100% (95% CI, 76.8-100%) sensitivity and 60% (95% CI, 44.3-73.6%) specificity for oxygen therapy at 6 months, with 100% specificity being found in 97 days. Conclusions: Patients with COVID-19 who require ECMO for >28 days can survive with nonlimiting lung impairment. Age and an awake ECMO strategy may be associated with survival. Longer duration of support correlates with need for oxygen therapy at 6 months.
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Affiliation(s)
- María Martínez-Martínez
- Department of Intensive Care, Vall d’Hebron University Hospital, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group (SODIR), Vall d’Hebron Research Institute, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matthieu Schmidt
- Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Lars Mikael Broman
- ECMO Centre Karolinska, Karolinska Universitetssjukhuset, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | | | - Elise Langouet
- Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Isabel Campos
- Department of Intensive Care, São João Universitary Hospital Center, Porto, Portugal; and
| | - Eduard Argudo
- Department of Intensive Care, Vall d’Hebron University Hospital, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group (SODIR), Vall d’Hebron Research Institute, Barcelona, Spain
| | - Josep Maria Domènech Vila
- Department of Intensive Care, Vall d’Hebron University Hospital, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group (SODIR), Vall d’Hebron Research Institute, Barcelona, Spain
| | - Sara Martín Sastre
- Department of Intensive Care, Vall d’Hebron University Hospital, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group (SODIR), Vall d’Hebron Research Institute, Barcelona, Spain
| | - Elisabet Gallart
- Department of Intensive Care, Vall d’Hebron University Hospital, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group (SODIR), Vall d’Hebron Research Institute, Barcelona, Spain
| | - Ricard Ferrer
- Department of Intensive Care, Vall d’Hebron University Hospital, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group (SODIR), Vall d’Hebron Research Institute, Barcelona, Spain
| | - Alain Combes
- Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jordi Riera
- Department of Intensive Care, Vall d’Hebron University Hospital, Barcelona, Spain
- Shock, Organ Dysfunction and Resuscitation Research Group (SODIR), Vall d’Hebron Research Institute, Barcelona, Spain
- Centro de Investigación Biomédica en Red (CIBER) de enfermedades respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain
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Jobst S, Schaefer J, Kleiser C, Kugler C. A Systematized Review of Professional Employment Following Thoracic Transplantation. Prog Transplant 2022; 32:55-66. [PMID: 35006009 DOI: 10.1177/15269248211064883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Acknowledging the evolved landscape in thoracic transplantation, professional employment becomes an important outcome measure to quantify the success of this costly procedure. OBJECTIVE We aimed to assess rates of and characterize factors associated with professional employment in patients following thoracic transplantation, and create an evidence-base on the relationship between professional employment and relevant outcome parameters. METHODS We systematically searched Medline, Cinahl, and GoogleScholar to identify studies published between 1998 and 2021 reporting on professional employment following heart and lung transplantation. RESULTS Twenty-two studies from 11 countries with varying sample sizes (N = 27; 10 066) were included. Employment rates ranged from 19.7% to 69.4% for heart, and from 7.4% to 50.8% for lung transplant recipients. Most frequently reported positively associated factors with employment after transplant were younger age, higher education, and history of pretransplant employment. Longer duration of unemployment prior to transplantation and Medicaid coverage were the most frequently reported negatively associated factors. Relationships between professional employment and clinical outcomes included lower rates of acute and chronic rejection, less infection episodes, and better quality of life among working patients; one study reported a lower 5-year-mortality rate. Reasons not to work were "physical or mental health-related," "employment-related," "financial reasons," and "lifestyle choices." DISCUSSION Substantial proportions of patients following thoracic transplantation are not professionally employed, potentially diminishing the success of transplantation on individual and societal levels. Considering adverse clinical outcomes in employed transplant recipients were low, more efforts are needed to identify modifiable factors for employment in these populations.
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Affiliation(s)
- Stefan Jobst
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Jonas Schaefer
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Christina Kleiser
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
| | - Christiane Kugler
- Institute of Nursing Science, University of Freiburg, Freiburg, Germany
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Groh JD, Dempster NR, Cole T, Hayes D. Navigating School Reentry in Lung Transplant Recipients With Cystic Fibrosis. Prog Transplant 2020; 30:278-280. [PMID: 32539558 DOI: 10.1177/1526924820933843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In addition to medical and psychological support, social support plays a key role in the success of lung transplant recipients, especially in children. An important component of that social support for pediatric lung transplant recipients is school reentry. These children face daily challenges, which often have to be addressed by the transplant team with little existing guidance in the medical literature. In this article, we discuss relevant practice issues for pediatric lung transplant recipients with cystic fibrosis including heightened concern for infection risk, bullying, school performance, and body image concerns. In addition to discussing these important issues, we provide recommendations based on our experiences.
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Affiliation(s)
- Jaclyn D Groh
- Division of Pain and Palliative Services, 2650Nationwide Children's Hospital, Columbus, OH, USA
| | - Nicole R Dempster
- Department of Psychiatry and Behavioral Health, 2650Nationwide Children's Hospital, Columbus, OH, USA
| | - Tina Cole
- The Heart Center, 2650Nationwide Children's Hospital, Columbus, OH, USA
| | - Don Hayes
- Division of Pulmonary Medicine, 63452Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Schuurmans MM, Hage R. [Work Reintegration after Lung Transplantation: A Complex and Multifaceted Topic]. PRAXIS 2020; 109:1013-1015. [PMID: 33050814 DOI: 10.1024/1661-8157/a003577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Macé M Schuurmans
- Universitätsspital Zürich, Klinik für Pneumologie, Zürich
- Universität Zürich, Medizinische Fakultät, Zürich
| | - René Hage
- Universitätsspital Zürich, Klinik für Pneumologie, Zürich
- Universität Zürich, Medizinische Fakultät, Zürich
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Schuurmans MM, Hage R. [Arbeitsintegration nach Lungentransplantation: ein komplexes, vielschichtiges Thema]. PRAXIS 2020; 109:1-3. [PMID: 33050818 DOI: 10.1024/1661-8157/a003578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Macé M Schuurmans
- University Hospital Zurich, Division of Pulmonology, Zurich, Switzerland
- University of Zurich, Medical Faculty, Zurich, Switzerland
| | - René Hage
- University Hospital Zurich, Division of Pulmonology, Zurich, Switzerland
- University of Zurich, Medical Faculty, Zurich, Switzerland
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Hemoptysis from complex pulmonary aspergilloma treated by cavernostomy and thoracoplasty. BMC Surg 2019; 19:187. [PMID: 31805919 PMCID: PMC6894504 DOI: 10.1186/s12893-019-0650-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In high-risk patients with complex pulmonary aspergilloma but unable for lung resection, cavernostomy and thoracoplasty could be performed. This study aimed to evaluate this surgery compared two compressing materials. METHODS A total of 63 in high-risk patients who suffered from hemoptysis due to complex pulmonary aspergilloma and underwent cavernostomy and thoracoplasty surgery from November 2011 to September 2018 at Pham Ngoc Thach hospital were evaluated prospectively studied. Patients were allocated to two groups: the table tennis ball group and tissue expander group. We evaluated at the time of before operation, 6 months and 24 months after operation. RESULTS Tuberculosis was the most common comorbidity diseases in both groups. Upper lobe occupied almost in location. Hemoptysis symptoms plunged from time to time. Statistically significant Karnofsky score was observed in both groups. Postoperative pulmonary functions (FVC and FEV1) have remained in both groups at all time points. The remarkable results were no deaths related to surgery and low complications both short and long-term. There was no statistical significance between two groups in operative time, blood loss during operation, ICU length-stay time. Four patients died because of co-morbidity in 24 months follow-up. CONCLUSION Cavernostomy and thoracoplasty was safe and effective surgery for the treatment of complex pulmonary aspergilloma with hemoptysis in high-risk patients. No mortality related to surgery and low complications were recorded. The was no inferiority when compared two compressing materials .
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Vieux L, Simcox AA, Mediouni Z, Wild P, Koller M, Studer RK, Danuser B. Predictors of Return to Work 12 Months After Solid Organ Transplantation: Results from the Swiss Transplant Cohort Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:462-471. [PMID: 30145704 DOI: 10.1007/s10926-018-9804-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Background Return to work with or after a chronic disease is not a very well understood process, influenced by a variety of personal, professional, societal and medical factors. The aim of this study is to identify predictors for return to work 12 months after a solid organ transplant applying a bio-psycho-social model. Methods This study is based on patients included in the Swiss Transplant Cohort Study, a national prospective multicentre cohort, who underwent a first solid organ transplant (kidney, liver, heart, lung). Bio-psycho-social factors were tested and predictors of return to work identified using logistic regression models. Results Among the 636 patients included in the study, 49.8% (317) were employed 12 months post-transplant. The major predictor for returning to work 12 months posttransplant was pre-transplant employment status (OR 10.8). Accordingly, the population was stratified in employed and not employed pre-transplant groups. Age, self-perceived health (6 months post-transplant) and the transplanted organ were significantly associated with post-transplant employment status in both groups. Return to work was influenced by education, depression (6 month post-transplant) and waiting time in the employed pre-transplant group and by invalidity pension in the not employed pre-transplant group. Conclusion Employment status pre-transplant being highly associated with employment status post-transplant, the process promoting return to work should be started well before surgery. Biomedical, psychological and social factors must be taken into account to promote return to work in transplanted patients.
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Affiliation(s)
- Laure Vieux
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland
| | - Amira A Simcox
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland
| | - Zakia Mediouni
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland.
| | - Pascal Wild
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland
| | - Michael Koller
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, 4031, Basel, Switzerland
| | - Regina K Studer
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland
| | - Brigitta Danuser
- Institut universitaire romand de Santé au Travail, Rte de la Corniche 2, 1066, Epalinges, Switzerland
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Osho A, Mulvihill M, Lamba N, Hirji S, Yerokun B, Bishawi M, Spencer P, Panda N, Villavicencio M, Hartwig M. Is Functional Independence Associated With Improved Long-Term Survival After Lung Transplantation? Ann Thorac Surg 2018; 106:79-84. [PMID: 29501640 DOI: 10.1016/j.athoracsur.2018.01.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Existing research demonstrates superior short-term outcomes (length of stay, 1-year survival) after lung transplantation in patients with preoperative functional independence. The aim of this study was to determine whether advantages remain significant in the long-term. METHODS The United Network for Organ Sharing database was queried for adult, first-time, isolated lung transplantation records from January 2005 to December 2015. Stratification was performed based on Karnofsky Performance Status Score (3 groups) and on employment at the time of transplantation (2 groups). Kaplan-Meier and Cox analyses were performed to determine the association between these factors and survival in the long-term. RESULTS Of 16,497 patients meeting criteria, 1,581 (9.6%) were almost completely independent at the time of transplant vs 5,662 (34.3%) who were disabled (completely reliant on others for activities of daily living). Cox models adjusting for recipient, donor, and transplant factors demonstrated a statistically significant association between disability at the time of transplant and long-term death (hazard ratio, 1.26; 95% confidence interval, 1.14 to 1.40; p < 0.001). There were 15,931 patients with available data on paid employment at the time of transplantation. Multivariable analysis demonstrated a statistically significant association between employment at the time of transplantation and death (hazard ratio, 0.86; 95% confidence interval, 0.75 to 0.91; p < 0.001). CONCLUSIONS Preoperative functional independence and maintenance of employment are associated with superior long-term outcomes in lung recipients. The results highlight potential benefits of pretransplant functional rehabilitation for patients on the waiting list for lungs.
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Affiliation(s)
- Asishana Osho
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Michael Mulvihill
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Nayan Lamba
- Harvard Medical School, Boston, Massachusetts
| | - Sameer Hirji
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Babatunde Yerokun
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Muath Bishawi
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Philip Spencer
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Nikhil Panda
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Matthew Hartwig
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Krivchenia K, Hayes D, Tobias JD, Tumin D. Long-term work participation among cystic fibrosis patients undergoing lung transplantation. J Cyst Fibros 2016; 15:846-849. [DOI: 10.1016/j.jcf.2016.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/12/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
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A Review of Lung Transplantation and Its Implications for the Acute Inpatient Rehabilitation Team. PM R 2016; 9:294-305. [DOI: 10.1016/j.pmrj.2016.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 12/12/2022]
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