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Shelley B, McAreavey R, McCall P. Epidemiology of perioperative RV dysfunction: risk factors, incidence, and clinical implications. Perioper Med (Lond) 2024; 13:31. [PMID: 38664769 PMCID: PMC11046908 DOI: 10.1186/s13741-024-00388-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
In this edition of the journal, the Perioperative Quality Initiative (POQI) present three manuscripts describing the physiology, assessment, and management of right ventricular dysfunction (RVD) as pertains to the perioperative setting. This narrative review seeks to provide context for these manuscripts, discussing the epidemiology of perioperative RVD focussing on definition, risk factors, and clinical implications. Throughout the perioperative period, there are many potential risk factors/insults predisposing to perioperative RVD including pre-existing RVD, fluid overload, myocardial ischaemia, pulmonary embolism, lung injury, mechanical ventilation, hypoxia and hypercarbia, lung resection, medullary reaming and cement implantation, cardiac surgery, cardiopulmonary bypass, heart and lung transplantation, and left ventricular assist device implantation. There has however been little systematic attempt to quantify the incidence of perioperative RVD. What limited data exists has assessed perioperative RVD using echocardiography, cardiovascular magnetic resonance, and pulmonary artery catheterisation but is beset by challenges resulting from the inconsistencies in RVD definitions. Alongside differences in patient and surgical risk profile, this leads to wide variation in the incidence estimate. Data concerning the clinical implications of perioperative RVD is even more scarce, though there is evidence to suggest RVD is associated with atrial arrhythmias and prolonged length of critical care stay following thoracic surgery, increased need for inotropic support in revision orthopaedic surgery, and increased critical care requirement and mortality following cardiac surgery. Acute manifestations of RVD result from low cardiac output or systemic venous congestion, which are non-specific to the diagnosis of RVD. As such, RVD is easily overlooked, and the relative contribution of RV dysfunction to postoperative morbidity is likely to be underestimated.We applaud the POQI group for highlighting this important condition. There is undoubtedly a need for further study of the RV in the perioperative period in addition to solutions for perioperative risk prediction and management strategies. There is much to understand, study, and trial in this area, but importantly for our patients, we are increasingly recognising the importance of these uncertainties.
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Affiliation(s)
- Ben Shelley
- Department of Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Clydebank, UK.
- Perioperative Medicine and Critical Care Research Group, University of Glasgow, Glasgow, UK.
| | - Rhiannon McAreavey
- Department of Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Clydebank, UK
- Perioperative Medicine and Critical Care Research Group, University of Glasgow, Glasgow, UK
| | - Philip McCall
- Department of Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital, Clydebank, UK
- Perioperative Medicine and Critical Care Research Group, University of Glasgow, Glasgow, UK
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Bottiger B, Klapper J, Fessler J, Shaz BH, Levy JH. Examining Bleeding Risk, Transfusion-related Complications, and Strategies to Reduce Transfusions in Lung Transplantation. Anesthesiology 2024; 140:808-816. [PMID: 38345894 DOI: 10.1097/aln.0000000000004829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Blood product transfusions for bleeding management in lung transplantation affect recipient outcomes. Interventions are needed to reduce perioperative bleeding risk and optimize outcomes.
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Affiliation(s)
- Brandi Bottiger
- Department of Anesthesiology, Cardiothoracic Anesthesiology Division, Duke University Medical Center, Durham, North Carolina
| | - Jacob Klapper
- Department of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Julien Fessler
- Department of Anesthesiology, Hôpital Foch, Suresnes, France
| | - Beth H Shaz
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Jerrold H Levy
- Department of Anesthesiology, Cardiothoracic Anesthesiology Division, Duke University Medical Center, Durham, North Carolina
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3
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Congedi S, Peralta A, Muraro L, Biscaro M, Pettenuzzo T, Sella N, Crociani S, Tagne AAS, Caregnato I, Monteleone F, Rossi E, Roca G, Manfrin S, Marinello S, Mazzitelli M, Dell'Amore A, Cattelan A, Rea F, Navalesi P, Boscolo A. Gram-negative bacterial colonizations before bilateral lung transplant. The impact of 'targeted' versus 'standard' surgical prophylaxis. BMC Infect Dis 2024; 24:307. [PMID: 38481174 PMCID: PMC10935849 DOI: 10.1186/s12879-024-09199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Infections are one of the most common causes of death after lung transplant (LT). However, the benefit of 'targeted' prophylaxis in LT recipients pre-colonized by Gram-negative (GN) bacteria is still unclear. METHODS All consecutive bilateral LT recipients admitted to the Intensive Care Unit of the University Hospital of Padua (February 2016-2023) were retrospectively screened. Only patients with pre-existing GN bacterial isolations were enrolled and analyzed according to the antimicrobial surgical prophylaxis ('standard' vs. 'targeted' on the preoperative bacterial isolation). RESULTS One hundred eighty-one LT recipients were screened, 46 enrolled. Twenty-two (48%) recipients were exposed to 'targeted' prophylaxis, while 24 (52%) to 'standard' prophylaxis. Overall prevalence of postoperative multi-drug resistant (MDR) GN bacteria isolation was 65%, with no differences between the two surgical prophylaxis (p = 0.364). Eleven (79%) patients treated with 'standard' prophylaxis and twelve (75%) with 'targeted' therapy reconfirmed the preoperative GN pathogen (p = 0.999). The prevalence of postoperative infections due to MDR GN bacteria was 50%. Of these recipients, 4 belonged to the 'standard' and 11 to the 'targeted' prophylaxis (p = 0.027). CONCLUSIONS The administration of a 'targeted' prophylaxis in LT pre-colonized recipients seemed not to prevent the occurrence of postoperative MDR GN infections.
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Affiliation(s)
- Sabrina Congedi
- Department of Medicine (DIMED), University of Padua, Padua, Italy
| | | | - Luisa Muraro
- Azienda Ospedale - Univerisità Padova, Padova, Italy
| | - Martina Biscaro
- Department of Medicine (DIMED), University of Padua, Padua, Italy
| | | | - Nicolò Sella
- Azienda Ospedale - Univerisità Padova, Padova, Italy.
| | - Silvia Crociani
- Department of Medicine (DIMED), University of Padua, Padua, Italy
| | | | - Ida Caregnato
- Department of Medicine (DIMED), University of Padua, Padua, Italy
| | | | - Elisa Rossi
- Azienda Ospedale - Univerisità Padova, Padova, Italy
| | | | - Silvia Manfrin
- Department of Medicine (DIMED), University of Padua, Padua, Italy
| | | | | | | | | | - Federico Rea
- Azienda Ospedale - Univerisità Padova, Padova, Italy
| | - Paolo Navalesi
- Department of Medicine (DIMED), University of Padua, Padua, Italy
- Azienda Ospedale - Univerisità Padova, Padova, Italy
| | - Annalisa Boscolo
- Department of Medicine (DIMED), University of Padua, Padua, Italy
- Azienda Ospedale - Univerisità Padova, Padova, Italy
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von Dossow V, Hulde N, Starke H, Schramm R. How Would We Treat Our Own Cystic Fibrosis With Lung Transplantation? J Cardiothorac Vasc Anesth 2024; 38:626-634. [PMID: 38030425 DOI: 10.1053/j.jvca.2023.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
Lung transplantation is the only therapy for patients with end-stage lung disease. In advanced lung diseases such as cystic fibrosis (CF), life expectancy increases, and it is important to recognize extrapulmonary comorbidities. Cardiovascular involvement, including pulmonary hypertension, right-heart failure, and myocardial dysfunction, are manifest in the late stages of CF disease. Besides right-heart failure, left-heart dysfunction seems to be underestimated. Therefore, an optimal anesthesia and surgical management risk evaluation in this high-risk patient population is mandatory, especially concerning the perioperative use of mechanical circulatory support. The use of an index case of an older patient with the diagnosis of cystic fibrosis demonstrates the importance of early risk stratification and strategy planning in a multidisciplinary team approach to guarantee successful lung transplantation.
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Affiliation(s)
- Vera von Dossow
- Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center Bad Oeynhausen, University Clinic of Ruhr-University Bochum, Bochum, Germany
| | - Nikolai Hulde
- Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center Bad Oeynhausen, University Clinic of Ruhr-University Bochum, Bochum, Germany.
| | - Henning Starke
- Institute of Anesthesiology and Pain Therapy, Heart and Diabetes Center Bad Oeynhausen, University Clinic of Ruhr-University Bochum, Bochum, Germany
| | - Rene Schramm
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center Bad Oeynhausen, University Clinic of Ruhr-University Bochum, Bochum, Germany
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Boscolo A, Cattelan A, Marinello S, Medici F, Pettenon G, Congedi S, Sella N, Presa N, Pistollato E, Silvestrin S, Biscaro M, Muraro L, Peralta A, Mazzitelli M, Dell’Amore A, Rea F, Navalesi P. Fungal Infections and Colonization after Bilateral Lung Transplant: A Six-Year Single-Center Experience. J Fungi (Basel) 2024; 10:80. [PMID: 38276026 PMCID: PMC10817539 DOI: 10.3390/jof10010080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/27/2024] Open
Abstract
Fungal infections (FIs) are one of the leading causes of morbidity and mortality within the first year of lung transplant (LT) in LT recipients (LTRs). Their prompt identification and treatment are crucial for a favorable LTR outcome. The objectives of our study were to assess (i) the FI incidence and colonization during the first year after a bilateral LT, (ii) the risk factors associated with FI and colonization, and (iii) the differences in fungal incidence according to the different prophylactic strategies. All bilateral LTRs admitted to the intensive care unit of Padua University Hospital were retrospectively screened, excluding patients <18 years of age, those who had been re-transplanted, and those who had received ventilation and/or extracorporeal membrane oxygenation before LT. Overall, 157 patients were included. A total of 13 (8%) patients developed FI, and 36 (23%) developed colonization, which was mostly due to Aspergillus spp. We did not identify independent risk factors for FI. Groups of patients receiving different prophylactic strategies reported a similar incidence of both FI and colonization. The incidence of FI and fungal colonization was 8% and 23%, respectively, with no differences between different antifungal prophylaxes or identified predisposing factors. Further studies with larger numbers are needed to confirm our results.
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Affiliation(s)
- Annalisa Boscolo
- Department of Medicine, University of Padua, 35122 Padua, Italy; (A.B.); (F.M.); (S.C.); (E.P.); (M.B.); (P.N.)
- Anesthesia and Intensive Care Unit, Padua University Hospital, 35128 Padua, Italy (L.M.); (A.P.)
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35122 Padua, Italy; (S.S.); (A.D.); (F.R.)
| | - Annamaria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy; (A.C.); (S.M.); (N.P.)
| | - Serena Marinello
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy; (A.C.); (S.M.); (N.P.)
| | - Francesca Medici
- Department of Medicine, University of Padua, 35122 Padua, Italy; (A.B.); (F.M.); (S.C.); (E.P.); (M.B.); (P.N.)
| | - Giovanni Pettenon
- Department of Medicine, University of Padua, 35122 Padua, Italy; (A.B.); (F.M.); (S.C.); (E.P.); (M.B.); (P.N.)
| | - Sabrina Congedi
- Department of Medicine, University of Padua, 35122 Padua, Italy; (A.B.); (F.M.); (S.C.); (E.P.); (M.B.); (P.N.)
| | - Nicolò Sella
- Anesthesia and Intensive Care Unit, Padua University Hospital, 35128 Padua, Italy (L.M.); (A.P.)
| | - Nicolò Presa
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy; (A.C.); (S.M.); (N.P.)
| | - Elisa Pistollato
- Department of Medicine, University of Padua, 35122 Padua, Italy; (A.B.); (F.M.); (S.C.); (E.P.); (M.B.); (P.N.)
| | - Stefano Silvestrin
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35122 Padua, Italy; (S.S.); (A.D.); (F.R.)
| | - Martina Biscaro
- Department of Medicine, University of Padua, 35122 Padua, Italy; (A.B.); (F.M.); (S.C.); (E.P.); (M.B.); (P.N.)
| | - Luisa Muraro
- Anesthesia and Intensive Care Unit, Padua University Hospital, 35128 Padua, Italy (L.M.); (A.P.)
| | - Arianna Peralta
- Anesthesia and Intensive Care Unit, Padua University Hospital, 35128 Padua, Italy (L.M.); (A.P.)
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy; (A.C.); (S.M.); (N.P.)
| | - Andrea Dell’Amore
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35122 Padua, Italy; (S.S.); (A.D.); (F.R.)
| | - Federico Rea
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, 35122 Padua, Italy; (S.S.); (A.D.); (F.R.)
| | - Paolo Navalesi
- Department of Medicine, University of Padua, 35122 Padua, Italy; (A.B.); (F.M.); (S.C.); (E.P.); (M.B.); (P.N.)
- Anesthesia and Intensive Care Unit, Padua University Hospital, 35128 Padua, Italy (L.M.); (A.P.)
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Kim JS, Gupta R. Lung transplantation in pulmonary sarcoidosis. J Autoimmun 2023:103135. [PMID: 37923622 DOI: 10.1016/j.jaut.2023.103135] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
Sarcoidosis is a systemic inflammatory disease of unknown etiology and variable clinical course. Pulmonary sarcoidosis is the most common presentation and accounts for most morbidity and mortality related to sarcoidosis. While sarcoidosis generally has good outcomes, few patients experience chronic disease. A minority of patients progress to a specific phenotype of sarcoidosis referred to advanced pulmonary sarcoidosis (APS) which includes advanced fibrosis, pulmonary hypertension and respiratory failure, leading to high morbidity and mortality. In patients with advanced disease despite medical therapy, lung transplantation may be the last viable option for improvement in quality of life. Though post-transplant survival is similar to that of other end-stage lung diseases, it is imperative that patients are evaluated and referred early to transplant centers with experience in APS. A multidisciplinary approach and clinical experience are crucial in detecting the optimal timing of referral, initiating comprehensive transplantation evaluation and listing, discussing surgical approach, and managing perioperative and post-transplant care. This review article seeks to address these aspects of lung transplantation in APS.
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Affiliation(s)
- Jin Sun Kim
- Lewis Katz School of Medicine, Department of Thoracic Medicine and Surgery, Philadelphia, PA, USA.
| | - Rohit Gupta
- Lewis Katz School of Medicine, Department of Thoracic Medicine and Surgery, Philadelphia, PA, USA
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Polastri M, Dell'Amore A, Reed RM, Pehlivan E. Handgrip Strength in Lung Transplant Candidates and Recipients. EXP CLIN TRANSPLANT 2023; 21:547-555. [PMID: 37486028 DOI: 10.6002/ect.2023.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
OBJECTIVES Handgrip strength is increasingly used to assess muscle strength in various conditions. In this review, we investigated handgrip strength in patients receiving or awaiting lung transplant. MATERIALS AND METHODS For this integrative review, we searched 8 databases from inception through February 2023. Two keyword entries, "handgrip strength" and "lung transplantation," were matched using the Boolean operator, AND. No filters were applied for document type, age, sex, publication date, language, and subject. RESULTS AND CONCLUSIONS The searched databases returned 73 citations. Nine articles considering 487 patients (49% female) were included in the final analysis; 7 studies were observational, and 2 were randomized controlled trials. In 7 of 9 studies, handgrip strength was measured with a hydraulic dynamometer. In candidates for lung transplant, handgrip strength ranged from 27.1 kg (before rehabilitation) to 31.2 kg (after rehabilitation). In lung transplant recipients, handgrip strength ranged from 21.1 kg (before rehabilitation) to 35.7 kg (after rehabilitation). Handgrip strength in lung transplant candidates with chronic obstructive pulmonary disease was higher (89 ± 18% predicted) versus patients with interstitial lung disease (79 ± 18% predicted). Improvements in maximal inspiratory pressure and maximal expiratory pressure were observed in those patients whose handgrip strength improved after rehabilitation. Nonsarcopenic patients walked longer distances for the 6-minute walking test (>450 m) versus sarcopenic patients (<310 m) and had higher handgrip strength (>20 kg) versus sarcopenic patients (<20 kg). Handgrip strength testing should be implemented both in preoperative and postoperative contexts to evaluate physical potential of patients and drive rehabilitative activities toward the most impaired domains.
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Affiliation(s)
- Massimiliano Polastri
- From the Department of Continuity of Care and Integration, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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8
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Verzelloni Sef A, Sef D, Trkulja V, Marczin N. Current Perspectives and Future Directions in Lung Transplantation. Life (Basel) 2023; 13:1432. [PMID: 37511807 PMCID: PMC10381398 DOI: 10.3390/life13071432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
This Special Issue of Life features compelling original research and reviews related to current trends in lung transplantation (LTx) [...].
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Affiliation(s)
- Alessandra Verzelloni Sef
- Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, London UB9 6JH, UK
| | - Davorin Sef
- Harefield Hospital, Royal Brompton and Harefield Hospitals, London UB9 6JH, UK
| | | | - Nandor Marczin
- Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, London UB9 6JH, UK
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK
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9
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Sef AV, Yin Ling CN, Aw TC, Romano R, Crescenzi O, Manikavasagar V, Simon A, de Waal EEC, Thakuria L, Reed AK, Marczin N. Postoperative vasoplegia in lung transplantation: incidence and relation to outcome. Br J Anaesth 2023; 130:666-676. [PMID: 37127440 DOI: 10.1016/j.bja.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 01/07/2023] [Accepted: 01/31/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The incidence and clinical importance of vasoplegia after lung transplantation remains poorly studied. We describe the incidence of vasoplegia and its association with complications after lung transplantation. METHODS Perioperative data of 279 lung transplant recipients operated on from 2015 to 2020 were retrospectively analysed. RESULTS Vasoplegia occurred in 41.6% of patients after lung transplantation (mild, 31.0%; moderate, 55.2%; severe, 13.8%). Compared with non-vasoplegic patients, vasoplegic patients had a higher incidence of any acute kidney injury, defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria (78.5% vs 65%, P=0.015), renal replacement therapy (47.4% vs 24.5%, P<0.001), and delayed chest closure (18.4% vs 9.2%, P=0.025); were ventilated longer (70 [32-368] vs 34 [19-105] h, P<0.001); and stayed longer in the ICU (12.9 [5-30] vs 6.8 [3-20] days, P<0.001). Mortality at 30 days and 1 yr was higher in patients with vasoplegia (11.2% vs 5.5% and 20.7% vs 11.7%, P=0.039, respectively). Severe vasoplegia represented a predictor of longer-term mortality (hazard ratio=1.65, P=0.008). Underlying infectious disease, increased BMI, higher preoperative pulmonary artery systolic pressure and bilirubin levels, lower glomerular filtration rate, and increased fresh frozen plasma transfusion were predictors of vasoplegia severity. Neutrophilia, leucocytosis, and increased C-reactive protein were associated with vasoplegia, but release of the neutrophil activation markers myeloperoxidase and heparin-binding protein was similar between groups. CONCLUSIONS Influenced by preoperative status as well as procedural factors and inflammatory response, vasoplegia is a common and critical condition after lung transplantation with worse short-term outcomes and long-term survival.
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Affiliation(s)
- Alessandra V Sef
- Department of Anesthesia and Critical Care, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Clarissa N Yin Ling
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Tuan C Aw
- Department of Anaesthesia, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rosalba Romano
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK; Department of Anaesthesia and Intensive Care, Cardarelli Hospital, Naples, Italy
| | - Oliviero Crescenzi
- Department of Anesthesia and Critical Care, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Venughanan Manikavasagar
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Andre Simon
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Eric E C de Waal
- Department of Anesthesiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Louit Thakuria
- Department of Cardiothoracic Transplantation and Mechanical Support, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anna K Reed
- Department of Cardiothoracic Transplantation and Mechanical Support, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nandor Marczin
- Department of Anesthesia and Critical Care, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK; Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK; Department of Anaesthesia and Intensive Care, Semmelweis University Budapest, Hungary.
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10
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Courtwright AM, Devarajan J, Fritz AV, Martin AK, Wilkey B, Subramani S, Cassara CM, Tawil JN, Miltiades AN, Boisen ML, Bottiger BA, Pollak A, Gelzinis TA. Cardiothoracic Transplant Anesthesia: Selected Highlights: Part I-Lung Transplantation. J Cardiothorac Vasc Anesth 2023; 37:884-903. [PMID: 36868904 DOI: 10.1053/j.jvca.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Affiliation(s)
| | | | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Jacksonville, FL
| | | | - Barbara Wilkey
- Department of Anesthesiology, University of Colorado, Aurora, CO
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Christopher M Cassara
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Justin N Tawil
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Andrea N Miltiades
- Department of Anesthesiology, Columbia University Medical Center, New York, NY
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Brandi A Bottiger
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Angela Pollak
- Department of Anesthesiology, Duke University, Durham, NC
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11
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Tanaka S, Tymowski CD, Tran-Dinh A, Meilhac O, Lortat-Jacob B, Zappella N, Jean-Baptiste S, Robert T, Goletto T, Godet C, Castier Y, Mal H, Mordant P, Atchade E, Messika J, Montravers P. Low HDL-Cholesterol Concentrations in Lung Transplant Candidates are Strongly Associated With One-Year Mortality After Lung Transplantation. Transpl Int 2023; 36:10841. [PMID: 36726695 PMCID: PMC9884674 DOI: 10.3389/ti.2023.10841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
High-density lipoproteins (HDLs), whose main role is the reverse transport of cholesterol, also have pleiotropic anti-inflammatory, antioxidant, anti-apoptotic and anti-infectious properties. During sepsis, HDL cholesterol (HDL-C) concentration is low, HDL particle functionality is altered, and these modifications are correlated with poor outcomes. Based on the protective effects of HDL, we hypothesized that HDL-C levels could be associated with lung transplantation (LT) outcome. We thus looked for an association between basal HDL-C concentration and one-year mortality after LT. In this single-center prospective study including consecutive LTs from 2015 to 2020, 215 patients were included, essentially pulmonary fibrosis (47%) and chronic obstructive pulmonary disease (COPD) (38%) patients. Mortality rate at one-year was 23%. Basal HDL-C concentration stratified nonsurvivors to survivors at one-year (HDL-C = 1.26 [1.12-1.62] mmol/L vs. HDL-C = 1.55 [1.22-1.97] mmol/L, p = 0.006). Multivariate analysis confirmed that HDL-C concentration during the pretransplant assessment period was the only variable inversely associated with mortality. Moreover, mortality at one-year in patients with HDL-C concentrations ≤1.45 mmol/L was significantly higher (log-rank test, p = 0.00085). In conclusion, low basal HDL-C concentrations in candidates for LT are strongly associated with mortality after LT. To better understand this association, further studies in this field are essential and, in particular, a better characterization of HDL particles seems necessary.
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Affiliation(s)
- Sébastien Tanaka
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,French Institute of Health and Medical Research (INSERM), U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Platform, Réunion Island University, Saint-Denis de La Réunion, France,*Correspondence: Sébastien Tanaka,
| | - Christian De Tymowski
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,French Institute of Health and Medical Research (INSERM) U1149, Center for Research on Inflammation, Paris, France
| | - Alexy Tran-Dinh
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,UFR Paris Nord, Université Paris Cité, Paris, France,Laboratory for Vascular Translational Science, French Institute of Health and Medical Research (INSERM) U1148, Paris, France
| | - Olivier Meilhac
- French Institute of Health and Medical Research (INSERM), U1188 Diabetes Atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Platform, Réunion Island University, Saint-Denis de La Réunion, France,Reunion Island University-Affiliated Hospital, Saint-Denis, France
| | - Brice Lortat-Jacob
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Nathalie Zappella
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Sylvain Jean-Baptiste
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Tiphaine Robert
- Department of Biochemistry, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Tiphaine Goletto
- Department of Pneumology and Lung Transplantation, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Cendrine Godet
- Department of Pneumology and Lung Transplantation, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
| | - Yves Castier
- UFR Paris Nord, Université Paris Cité, Paris, France,Laboratory for Vascular Translational Science, French Institute of Health and Medical Research (INSERM) U1148, Paris, France,Department of Vascular and Thoracic Surgery, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Hervé Mal
- UFR Paris Nord, Université Paris Cité, Paris, France,Department of Pneumology and Lung Transplantation, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
| | - Pierre Mordant
- UFR Paris Nord, Université Paris Cité, Paris, France,Laboratory for Vascular Translational Science, French Institute of Health and Medical Research (INSERM) U1148, Paris, France,Department of Vascular and Thoracic Surgery, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Enora Atchade
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France
| | - Jonathan Messika
- UFR Paris Nord, Université Paris Cité, Paris, France,Department of Pneumology and Lung Transplantation, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France,Paris Transplant Group, Paris, France
| | - Philippe Montravers
- Department of Anesthesiology and Critical Care Medicine, Assistance Publique—Hôpitaux de Paris (AP-HP), Bichat-Claude Bernard Hospital, Paris, France,UFR Paris Nord, Université Paris Cité, Paris, France,PHERE, Physiopathology and Epidemiology of Respiratory Diseases, French Institute of Health and Medical Research (INSERM) U1152, Paris, France
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12
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Fessler J, Finet M, Fischler M, Le Guen M. New Aspects of Lung Transplantation: A Narrative Overview Covering Important Aspects of Perioperative Management. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010092. [PMID: 36676041 PMCID: PMC9865529 DOI: 10.3390/life13010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/26/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
The management of lung transplant patients has continued to evolve in recent years. The year 2021 was marked by the publication of the International Consensus Recommendations for Anesthetic and Intensive Care Management of Lung Transplantation. There have been major changes in lung transplant programs over the last few years. This review will summarize the knowledge in anesthesia management of lung transplantation with the most recent data. It will highlight the following aspects which concern anesthesiologists more specifically: (1) impact of COVID-19, (2) future of transplantation for cystic fibrosis patients, (3) hemostasis management, (4) extracorporeal membrane oxygenation management, (5) early prediction of primary graft dysfunction, and (6) pain management.
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Affiliation(s)
- Julien Fessler
- Department of Anesthesiology and Pain Management, Hospital Foch, 92150 Suresnes, France
| | - Michaël Finet
- Department of Anesthesiology and Pain Management, Hospital Foch, 92150 Suresnes, France
| | - Marc Fischler
- Department of Anesthesiology and Pain Management, Hospital Foch, 92150 Suresnes, France
- Correspondence:
| | - Morgan Le Guen
- Department of Anesthesiology and Pain Management, Hospital Foch, 92150 Suresnes, France
- University Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
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13
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Multidrug-Resistant and Extended-Spectrum β-Lactamase Gram-Negative Bacteria in Bilateral Lung Transplant Recipients: Incidence, Risk Factors, and In-Hospital Mortality. Chest 2022; 162:1255-1264. [PMID: 35850288 DOI: 10.1016/j.chest.2022.06.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/12/2022] [Accepted: 06/27/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In recent decades, the incidence of multidrug-resistant (MDR) and extended-spectrum β-lactamase (ESBL) gram-negative (GN) bacteria has increased progressively among lung transplantation (LT) recipients. A prompt diagnosis, prevention, and management of these pathogens remain the cornerstone for successful organ transplantation. RESEARCH QUESTION What are the incidence of MDR and ESBL GN bacteria within the first 30 days after LT and related risk of in-hospital mortality? What are the potential clinical predictors of isolation of MDR and ESBL GN bacteria? STUDY DESIGN AND METHODS All consecutive LT recipients admitted to the ICU of the University Hospital of Padua (February 2016-December 2021) were screened retrospectively. Only adult patients undergoing the first bilateral LT and not requiring invasive mechanical ventilation, extracorporeal membrane oxygenation, or both before surgery were included. MDR and ESBL GN bacteria were identified using in vitro susceptibility tests and were isolated from the respiratory tract, blood, urine, rectal swab, or surgical wound or drainage according to a routine protocol. RESULTS One hundred fifty-three LT recipients were screened, and 132 were considered for analysis. Median age was 52 years (interquartile range, 41-60 years) and 46 patients (35%) were women. MDR and ESBL GN bacteria were identified in 45 patients (34%), and 60% of patients demonstrated clinically relevant infection. Pseudomonas aeruginosa (n = 22 [49%]) and Klebsiella pneumoniae (n = 17 [38%]) were frequently isolated after LT from the respiratory tract (n = 21 [47%]) and multiple sites (n = 18 [40%]). Previous recipient-related colonization (hazard ratio [HR], 2.48 [95% CI, 1.04-5.90]; P = .04) and empirical exposure to broad-spectrum antibiotics (HR, 6.94 [95% CI, 2.93-16.46]; P < .01) were independent predictors of isolation of MDR and ESBL GN bacteria. In-hospital mortality of the MDR and ESBL group was 27% (HR, 6.38 [95% CI, 1.98-20.63]; P < .01). INTERPRETATION The incidence of MDR and ESBL GN bacteria after LT was 34%, and in-hospital mortality was six times greater. Previous recipient-related colonization and empirical exposure to broad-spectrum antibiotics were clinical predictors of isolation of MDR and ESBL GN bacteria.
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14
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Siddique A, Sabbah BN, Arabi T, Shakir IM, Abdulqawi R, AlKattan K, Ahmed MH. Treatment of bronchial anastomotic fistula using autologous platelet-rich plasma post lung transplantation. J Cardiothorac Surg 2022; 17:204. [PMID: 36002865 PMCID: PMC9404593 DOI: 10.1186/s13019-022-01965-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bronchial anastomotic dehiscence is considered one of the most catastrophic early airway complications post-transplant. The presence of a partial dehiscence can also cause further complications such as a fistula between the bronchus and the pleural membrane. Platelet-rich plasma (PRP) is known to significantly enhance the healing process and is being used in the treatment of various conditions, however, so far, there are no reports of the use of PRP in the treatment of bronchial anastomotic dehiscence fistula. CASE PRESENTATION We present a 37-year-old male, with non-cystic fibrosis bronchiectasis underwent bilateral lung transplantation. The patient developed partial dehiscence of the right bronchial anastomosis that was complicated by a small bronchopleural fistula. Two bronchoscopic applications of autologous platelet-rich plasma were carried out. Follow-up a few weeks later showed complete closure and healing of the fistula. CONCLUSIONS This case report suggests that the treatment of post-lung transplant small bronchial anastomotic partial dehiscence fistula with PRP is safe and effective.
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Affiliation(s)
- Aisha Siddique
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Tarek Arabi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ismail Mohammed Shakir
- Department of Anatomy and Cell Biology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Rayid Abdulqawi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. .,Lung Health Centre, Organ Transplant Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
| | - Khaled AlKattan
- Lung Health Centre, Organ Transplant Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,Department of Surgery, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohamed Hussein Ahmed
- Lung Health Centre, Organ Transplant Centre of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,Department of Cardiothoracic Surgery, Ain Shams University, Cairo, Egypt
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15
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Jeon K. Critical Care Management Following Lung Transplantation. J Chest Surg 2022; 55:325-331. [PMID: 35924541 PMCID: PMC9358155 DOI: 10.5090/jcs.22.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Postoperative critical care management for lung transplant recipients in the intensive care unit (ICU) has expanded in recent years due to its complexity and impact on clinical outcomes. The practical aspects of post-transplant critical care management, especially regarding ventilation and hemodynamic management during the early postoperative period in the ICU, are discussed in this brief review. Monitoring in the ICU provides information on the patient’s clinical status, diagnostic assessment of complications, and future management plans since lung transplantation involves unique pathophysiological conditions and risk factors for complications. After lung transplantation, the grafts should be appropriately ventilated with lung protective strategies to prevent ventilator-induced lung injury, as well as to promote graft function and maintain adequate gas exchange. Hypotension and varying degrees of pulmonary edema are common in the immediate postoperative lung transplantation setting. Ventricular dysfunction in lung transplant recipients should also be considered. Therefore, adequate volume and hemodynamic management with vasoactive agents based on their physiological effects and patient response are critical in the early postoperative lung transplantation period. Integrated management provided by a professional multidisciplinary team is essential for the critical care management of lung transplant recipients in the ICU.
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Affiliation(s)
- Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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Starke H, von Dossow V, Karsten J. Intraoperative Circulatory Support in Lung Transplantation: Current Trend and Its Evidence. LIFE (BASEL, SWITZERLAND) 2022; 12:life12071005. [PMID: 35888094 PMCID: PMC9322250 DOI: 10.3390/life12071005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
Lung transplantation has a high risk of haemodynamic complications in a highly vulnerable patient population. The effects on the cardiovascular system of the various underlying end-stage lung diseases also contribute to this risk. Following a literature review and based on our own experience, this review article summarises the current trends and their evidence for intraoperative circulatory support in lung transplantation. Identifiable and partly modifiable risk factors are mentioned and corresponding strategies for treatment are discussed. The approach of first identifying risk factors and then developing an adjusted strategy is presented as the ERSAS (early risk stratification and strategy) concept. Typical haemodynamic complications discussed here include right ventricular failure, diastolic dysfunction caused by left ventricular deconditioning, and reperfusion injury to the transplanted lung. Pre- and intra-operatively detectable risk factors for the occurrence of haemodynamic complications are rare, and the therapeutic strategies applied differ considerably between centres. However, all the mentioned risk factors and treatment strategies can be integrated into clinical treatment algorithms and can influence patient outcome in terms of both mortality and morbidity.
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Affiliation(s)
- Henning Starke
- Institute of Anaesthesiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum, 44801 Bochum, Germany;
| | - Vera von Dossow
- Institute of Anaesthesiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum, 44801 Bochum, Germany;
- Correspondence: ; Tel.: +49-(0)-5731-97-1128; Fax: +49-(0)-5731-97-2196
| | - Jan Karsten
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany;
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17
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Martin AK. International Consensus Recommendations for Lung Transplantation Anesthetic Management: A New Perioperative Paradigm. J Cardiothorac Vasc Anesth 2022; 36:2854-2856. [DOI: 10.1053/j.jvca.2022.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 11/11/2022]
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