1
|
Westhoff M, Neumann P, Geiseler J, Bickenbach J, Arzt M, Bachmann M, Braune S, Delis S, Dellweg D, Dreher M, Dubb R, Fuchs H, Hämäläinen N, Heppner H, Kluge S, Kochanek M, Lepper PM, Meyer FJ, Neumann B, Putensen C, Schimandl D, Schönhofer B, Schreiter D, Walterspacher S, Windisch W. [Non-invasive Mechanical Ventilation in Acute Respiratory Failure. Clinical Practice Guidelines - on behalf of the German Society of Pneumology and Ventilatory Medicine]. Pneumologie 2024; 78:453-514. [PMID: 37832578 DOI: 10.1055/a-2148-3323] [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: 10/15/2023]
Abstract
The guideline update outlines the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.Non-invasive ventilation (NIV) has a high value in therapy of hypercapnic acute respiratory failure, as it significantly reduces the length of ICU stay and hospitalization as well as mortality.Patients with cardiopulmonary edema and acute respiratory failure should be treated with continuous positive airway pressure (CPAP) and oxygen in addition to necessary cardiological interventions. This should be done already prehospital and in the emergency department.In case of other forms of acute hypoxaemic respiratory failure with only mild or moderately disturbed gas exchange (PaO2/FiO2 > 150 mmHg) there is no significant advantage or disadvantage compared to high flow nasal oxygen (HFNO). In severe forms of ARDS NIV is associated with high rates of treatment failure and mortality, especially in cases with NIV-failure and delayed intubation.NIV should be used for preoxygenation before intubation. In patients at risk, NIV is recommended to reduce extubation failure. In the weaning process from invasive ventilation NIV essentially reduces the risk of reintubation in hypercapnic patients. NIV is regarded useful within palliative care for reduction of dyspnea and improving quality of life, but here in concurrence to HFNO, which is regarded as more comfortable. Meanwhile NIV is also recommended in prehospital setting, especially in hypercapnic respiratory failure and pulmonary edema.With appropriate monitoring in an intensive care unit NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency.
Collapse
Affiliation(s)
- Michael Westhoff
- Klinik für Pneumologie, Lungenklinik Hemer - Zentrum für Pneumologie und Thoraxchirurgie, Hemer
| | - Peter Neumann
- Abteilung für Klinische Anästhesiologie und Operative Intensivmedizin, Evangelisches Krankenhaus Göttingen-Weende gGmbH
| | - Jens Geiseler
- Medizinische Klinik IV - Pneumologie, Beatmungs- und Schlafmedizin, Paracelsus-Klinik Marl, Marl
| | - Johannes Bickenbach
- Klinik für Operative Intensivmedizin und Intermediate Care, Uniklinik RWTH Aachen, Aachen
| | - Michael Arzt
- Schlafmedizinisches Zentrum der Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg
| | - Martin Bachmann
- Klinik für Atemwegs-, Lungen- und Thoraxmedizin, Beatmungszentrum Hamburg-Harburg, Asklepios Klinikum Harburg, Hamburg
| | - Stephan Braune
- IV. Medizinische Klinik: Akut-, Notfall- und Intensivmedizin, St. Franziskus-Hospital, Münster
| | - Sandra Delis
- Klinik für Pneumologie, Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring GmbH, Berlin
| | - Dominic Dellweg
- Klinik für Innere Medizin, Pneumologie und Gastroenterologie, Pius-Hospital Oldenburg, Universitätsmedizin Oldenburg
| | - Michael Dreher
- Klinik für Pneumologie und Internistische Intensivmedizin, Uniklinik RWTH Aachen
| | - Rolf Dubb
- Akademie der Kreiskliniken Reutlingen GmbH, Reutlingen
| | - Hans Fuchs
- Zentrum für Kinder- und Jugendmedizin, Neonatologie und pädiatrische Intensivmedizin, Universitätsklinikum Freiburg
| | | | - Hans Heppner
- Klinik für Geriatrie und Geriatrische Tagesklinik Klinikum Bayreuth, Medizincampus Oberfranken Friedrich-Alexander-Universität Erlangen-Nürnberg, Bayreuth
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Matthias Kochanek
- Klinik I für Innere Medizin, Hämatologie und Onkologie, Universitätsklinikum Köln, Köln
| | - Philipp M Lepper
- Klinik für Innere Medizin V - Pneumologie, Allergologie und Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - F Joachim Meyer
- Lungenzentrum München - Bogenhausen-Harlaching) München Klinik gGmbH, München
| | - Bernhard Neumann
- Klinik für Neurologie, Donauisar Klinikum Deggendorf, und Klinik für Neurologie der Universitätsklinik Regensburg am BKH Regensburg, Regensburg
| | - Christian Putensen
- Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn
| | - Dorit Schimandl
- Klinik für Pneumologie, Beatmungszentrum, Zentralklinik Bad Berka GmbH, Bad Berka
| | - Bernd Schönhofer
- Klinik für Innere Medizin, Pneumologie und Intensivmedizin, Evangelisches Klinikum Bethel, Universitätsklinikum Ost Westphalen-Lippe, Bielefeld
| | | | - Stephan Walterspacher
- Medizinische Klinik - Sektion Pneumologie, Klinikum Konstanz und Lehrstuhl für Pneumologie, Universität Witten-Herdecke, Witten
| | - Wolfram Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Lehrstuhl für Pneumologie Universität Witten/Herdecke, Köln
| |
Collapse
|
2
|
Habib A, Gouchoe DA, Rosenheck JP, Mokadam NA, Henn MC, Nunley DR, Ramsammy V, Whitson BA, Ganapathi AM. Early Extubation: Who Qualifies Postoperatively in Lung Transplantation? J Surg Res 2024; 299:303-312. [PMID: 38788467 DOI: 10.1016/j.jss.2024.04.061] [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: 09/25/2023] [Revised: 03/30/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Early extubation has been adopted in many settings within cardiothoracic surgery, with several advantages for patients. We sought to determine the association of timing of extubation in lung transplant recipients' short- and long-term outcomes. METHODS Adult, primary lung transplants were identified from the United Network for Organ Sharing database. Recipients were stratified based on the duration of postoperative ventilation: 1) None (NV); 2) <5 Days (<5D); and 3) 5+ Days (5+D). Comparative statistics were performed, and both unadjusted and adjusted survival were analyzed with Kaplan-Meier Methods and a Cox proportional hazard model. A multivariable model including recipient, donor, and transplant characteristics was created to examine factors associated with NV. RESULTS 28,575 recipients were identified (NV = 960, <5D = 21,959, 5+D = 5656). The NV group had shorter median length of stay (P < 0.01) and lower incidence of postoperative dialysis (P < 0.01). The NV and <5D groups had similar survival, while 5+D recipients had decreased survival (P < 0.01). The multivariable model demonstrated increased donor BMI, center volume, ischemic time, single lung transplant, and transplantation between 2011 and 2015 were associated with NV (P < 0.01 for all). Use of donation after cardiac death donors and transplantation between 2016 and 2021 was associated with postoperative ventilator use. CONCLUSIONS Patients extubated early after lung transplantation have a shorter median length of stay without an associated increase in mortality. While not all patients are appropriate for earlier extubation, it is possible to extubate patients early following lung transplant. Further efforts are necessary to help expand this practice and ensure its' success for recipients.
Collapse
Affiliation(s)
- Alim Habib
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Doug A Gouchoe
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Justin P Rosenheck
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nahush A Mokadam
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Matthew C Henn
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David R Nunley
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Verai Ramsammy
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bryan A Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Asvin M Ganapathi
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| |
Collapse
|
3
|
Fessler J, Fischler M, Le Guen M. From a good idea to the best practice! J Heart Lung Transplant 2023; 42:1768-1769. [PMID: 37532085 DOI: 10.1016/j.healun.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023] Open
Affiliation(s)
- Julien Fessler
- Department of Anesthesiology and Pain Medicine, Hôpital Foch, Suresnes, France; Université de Versailles Saint-Quentin-en-Yvelines, Paris-Saclay, Versailles, France.
| | - Marc Fischler
- Department of Anesthesiology and Pain Medicine, Hôpital Foch, Suresnes, France; Université de Versailles Saint-Quentin-en-Yvelines, Paris-Saclay, Versailles, France
| | - Morgan Le Guen
- Department of Anesthesiology and Pain Medicine, Hôpital Foch, Suresnes, France; Université de Versailles Saint-Quentin-en-Yvelines, Paris-Saclay, Versailles, France
| |
Collapse
|
4
|
Labarinas S, Coss-Bu JA, Onyearugbulem C, Heinle JS, Mallory GB, Gazzaneo MC. Influence of early extubation on post-operative outcomes after pediatric lung transplantation. Pediatr Transplant 2021; 25:e13776. [PMID: 32780552 DOI: 10.1111/petr.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 11/27/2022]
Abstract
Lung transplantation has become an accepted therapeutic option for a select group of children with end-stage lung disease. We evaluated the impact of early extubation in a pediatric lung transplant population and its post-operative outcomes. Single-center retrospective study. PICU within a tertiary academic pediatric hospital. Patients <22 years after pulmonary transplant between January 2011 and December 2016. A total of 74 patients underwent lung transplantation. The primary pretransplantation diagnoses included cystic fibrosis (58%), pulmonary fibrosis (9%), and surfactant dysfunction disorders (10%). Of 60 patients, 36 (60%) were extubated within 24 hours and 24 patients after 24 hours (40%). A total of seven patients (11.6%) required reintubation within 24 hours. Median length of stay for the early extubation group was shorter at 3 days ([(IQR) 2.2-4.7]) compared to 5 days (IQR, 3-7) (P = .02) in the late extubation group. Median costs were lower for the early extubation group with 13,833 US dollars (IQR, 9980-22,822) vs 23 671 US dollars (IQR, 16 673-39 267) (P = .043). Fourteen patients were in the PICU prior to their transplantation; this did not affect their early extubation success. Neither did the fact of requiring invasive or non-invasive mechanical ventilation before transplantation. Early extubation appears to be safe in a pediatric population after lung transplantation and is associated with a shorter LOS and decreased hospital costs. It may prevent known complications associated with mechanical ventilation.
Collapse
Affiliation(s)
- Sonia Labarinas
- Section of Critical Care Medicine, Department of Pediatrics, The University of Texas Health Science Center, Houston, TX, USA
| | - Jorge A Coss-Bu
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Chinyere Onyearugbulem
- Section of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Edinburg, TX, USA
| | - Jeffery S Heinle
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine, TX, USA
| | - George B Mallory
- Section of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Maria C Gazzaneo
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Section of Pulmonary Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
5
|
Operating room extubation: A predictive factor for 1-year survival after double-lung transplantation. J Heart Lung Transplant 2021; 40:334-342. [PMID: 33632637 DOI: 10.1016/j.healun.2021.01.1965] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 01/24/2021] [Accepted: 01/30/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Operating room (OR) extubation has been reported after lung transplantation (LT) in small cohorts. This study aimed to evaluate the prognosis of OR-extubated patients. The secondary objectives were to evaluate the safety of this approach and to identify its predictive factors. METHODS This retrospective single-center cohort study included patients undergoing double lung transplantation (DLT) from January 2012 to June 2019. Patients undergoing multiorgan transplantation, repeat transplantation, or cardiopulmonary bypass during the study period were excluded. OR-extubated patients were compared with intensive care unit (ICU)-extubated patients. RESULTS Among the 450 patients included in the analysis, 161 (35.8%) were extubated in the OR, and 4 were reintubated within 24 hours. Predictive factors for OR extubation were chronic obstructive pulmonary disease (COPD)/emphysema (p = .002) and cystic fibrosis (p = .005), recipient body mass index (p = .048), and the PaO2/FiO2 ratio 10 minutes after second graft implantation (p < .001). OR-extubated patients had a lower prevalence of grade 3 primary graft dysfunction at day 3 (p < .001). Eight (5.0%) patients died within the first year after OR extubation, and 49 (13.5%) patients died after ICU extubation (log-rank test; p = .005). After adjustment for OR extubation predictive factors, the multivariate Cox regression model showed that OR extubation was associated with greater one-year survival (adjusted hazard ratio = 0.40 [0.16-0.91], p = .028). CONCLUSIONS OR extubation was associated with a favorable prognosis after DLT, but the association should not be interpreted as causality. This fast-track protocol was made possible by a team committed to developing a comprehensive strategy to enhance recovery.
Collapse
|
6
|
Li R, Shi J, Huang D, Chen Y, Cui W, Liang H, Liang W, Peng G, Yang C, Liu M, Kuang M, Xu X, He J. Preoperative risk factors for successful extubation or not after lung transplantation. J Thorac Dis 2020; 12:7135-7144. [PMID: 33447402 PMCID: PMC7797869 DOI: 10.21037/jtd-20-2546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The purpose of this study was to uncover preoperative risk factors for extubation failure or re-intubation for patients undergoing lung transplant (LTx). Methods We performed a retrospective case-control study of LTx from our center between January 2017 and March 2019. Demographic and preoperative characteristics were collected for all included patients. Univariable analysis and multivariable logistic regression were used to analyze risk factors of postoperative unsuccessful extubation following LTx. Results Among 107 patients undergoing first LTx investigated, 74 (69.16%) patients who were successfully liberated from mechanical ventilation (MV), and 33 (30.84%) patients who were unsuccessful extubation, which 18 (16.82%) patients suffered from reintubation. associated preoperative factors for unsuccessful extubation following LTx included preoperative extracorporeal membrane oxygenation (ECMO) support [OR =4.631, 95% confidence interval (CI): 1.403–15.286, P=0.012], the preoperative ability of independent expectoration (OR =4.517, 95% CI: 1.498–13.625, P=0.007), the age older than 65-year-old (OR =4.039, 95% CI: 1.154–14.139, P=0.029), and receiving the double lung and heart-LTx (OR =3.390, 95% CI: 0.873–13.162, P=0.078; and OR =16.579, 95% CI: 2.586–106.287, P=0.012, respectively). Further, we investigated the preoperative predicted factors for reintubation. Only the preoperative ECMO remained a significant predictor of re-intubation (OR =4.69, 95% CI: 1.56–15.286, P=0.012). Conclusions Preoperative independent sputum clearance, preoperative ECMO, older than 65-year-old, and double lung or heart-LTx were four independent risk factors for unsuccessful extubation. Moreover, preoperative ECMO was the only independent risk factor for reintubation.
Collapse
Affiliation(s)
- Run Li
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiang Shi
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Danxia Huang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ying Chen
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weixue Cui
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guilin Peng
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chao Yang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mengyang Liu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Minting Kuang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xin Xu
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
7
|
Fessler J, Davignon M, Sage E, Roux A, Cerf C, Feliot E, Gayat E, Parquin F, Fischler M, Guen ML. Intraoperative Implications of the Recipients' Disease for Double-Lung Transplantation. J Cardiothorac Vasc Anesth 2020; 35:530-538. [PMID: 32741611 DOI: 10.1053/j.jvca.2020.07.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To compare intraoperative patterns among patients based on their primary pulmonary disease (cystic fibrosis [CF], chronic obstructive pulmonary disease [COPD]/emphysema [CE], and pulmonary fibrosis [PF]) during double- lung transplantation. The following 3 major outcomes were reported: blood transfusion, extracorporeal membrane oxygenation (ECMO) management, and the possibility of immediate extubation at the end of surgery. DESIGN Retrospective analysis of a prospectively maintained database, including donor and recipient characteristics and intraoperative variables. SETTING Foch Hospital, Suresnes, France (academic center performing 60-80 lung transplantations per year). PARTICIPANTS Patients who underwent double- lung transplantation from 2012-2019. Patients with retransplantation, multiorgan transplantation, or surgery performed with cardiopulmonary bypass were excluded. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two hundred forty-six patients had CF, 117 had CE, and 66 had PF. No patient had primary pulmonary arterial hypertension. Blood transfusion was higher in the CF group than in the other 2 groups (red blood cells [p < 0.001], fresh frozen plasma [p = 0.004]). The CF and CE groups were characterized by a lower intraoperative requirement of ECMO (p = 0.002), and the PF group more frequently required postoperative ECMO (p < 0.001). CF and CE patients were more frequently extubated in the operating room than were PF patients (37.4%, 50.4%, and 13.6%, respectively; p < 0.001). CONCLUSIONS Intraoperative outcomes differed depending on the initial pathology. Such differences should be taken into account in specific clinical studies and in intraoperative management protocols.
Collapse
Affiliation(s)
- Julien Fessler
- Department of Anesthesiology, Hôpital Foch, 9250 Suresnes, France; Université Versailles-Saint-Quentin-en-Yvelines, 78646 Versailles, France
| | - Maxime Davignon
- Department of Anesthesiology, Hôpital Foch, 9250 Suresnes, France; Université Versailles-Saint-Quentin-en-Yvelines, 78646 Versailles, France
| | - Edouard Sage
- Université Versailles-Saint-Quentin-en-Yvelines, 78646 Versailles, France; Department of Thoracic Surgery, Hôpital Foch, 9250 Suresnes, France
| | - Antoine Roux
- Université Versailles-Saint-Quentin-en-Yvelines, 78646 Versailles, France; Department of Pneumology, Hôpital Foch, 9250 Suresnes, France
| | - Charles Cerf
- Department of Intensive Care, Hôpital Foch, 9250 Suresnes, France
| | - Elodie Feliot
- Department of Anesthesiology and Critical Care Medicine, Hôpital Saint Louis - Lariboisière, 75010 Paris, France; Institut National de la Santé et de la Recherche Médicale, 75654 Paris, France
| | - Etienne Gayat
- Department of Anesthesiology and Critical Care Medicine, Hôpital Saint Louis - Lariboisière, 75010 Paris, France; Institut National de la Santé et de la Recherche Médicale, 75654 Paris, France
| | - Francois Parquin
- Université Versailles-Saint-Quentin-en-Yvelines, 78646 Versailles, France; Department of Thoracic Surgery, Hôpital Foch, 9250 Suresnes, France
| | - Marc Fischler
- Department of Anesthesiology, Hôpital Foch, 9250 Suresnes, France; Université Versailles-Saint-Quentin-en-Yvelines, 78646 Versailles, France.
| | - Morgan Le Guen
- Department of Anesthesiology, Hôpital Foch, 9250 Suresnes, France; Université Versailles-Saint-Quentin-en-Yvelines, 78646 Versailles, France
| |
Collapse
|
8
|
McLean SR, von Homeyer P, Cheng A, Hall ML, Mulligan MS, Cain K, Togashi K. Assessing the Benefits of Preoperative Thoracic Epidural Placement for Lung Transplantation. J Cardiothorac Vasc Anesth 2018; 32:2654-2661. [DOI: 10.1053/j.jvca.2018.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Indexed: 12/24/2022]
|
9
|
Gelzinis TA. An Update on Postoperative Analgesia Following Lung Transplantation. J Cardiothorac Vasc Anesth 2018; 32:2662-2664. [DOI: 10.1053/j.jvca.2018.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Indexed: 11/11/2022]
|
10
|
Assenzo V, Assenzo C, Filippo R, Le Guen M, Sage E, Roux A, Fischler M, Liu N. The feasibility of extubation in the operating room after bilateral lung transplantation in adult emphysema patients: an observational retrospective study. Eur J Cardiothorac Surg 2018; 54:1128-1133. [DOI: 10.1093/ejcts/ezy196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/16/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Valentina Assenzo
- Department of Anaesthesia, Foch Hospital, Suresnes, France
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Morgan Le Guen
- Department of Anaesthesia, Foch Hospital, Suresnes, France
| | - Edouard Sage
- Department of Thoracic Surgery, Foch Hospital, Suresnes, France
| | - Antoine Roux
- Department of Pneumology, Foch Hospital, Suresnes, France
| | - Marc Fischler
- Department of Anaesthesia, Foch Hospital, Suresnes, France
| | - Ngai Liu
- Department of Anaesthesia, Foch Hospital, Suresnes, France
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
11
|
Felten ML, Moyer JD, Dreyfus JF, Marandon JY, Sage E, Roux A, Parquin F, Cerf C, Zuber B, Le Guen M, Fischler M. Immediate postoperative extubation in bilateral lung transplantation: predictive factors and outcomes † †Presented in part as an oral presentation at the American Transplant Congress (Philadelphia, PA, USA; May 2015). Br J Anaesth 2016; 116:847-54. [DOI: 10.1093/bja/aew119] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 01/26/2023] Open
|
12
|
Abstract
Lung transplantation (LT) is the only viable option for a selected group of patients with end stage pulmonary diseases. During the recent years satisfactory results in terms of long-term survival and quality of life have been achieved with improvements in surgical technique, immunosuppression and perioperative management. Since the beginning, the airway anastomosis has been considered crucial and significant efforts have been made to understand the healing process. A number of experimental studies allowed improving the surgical technique by modifying the technique of suturing, the anastomotic protection and type and dose of immunosuppression, reducing the risk of airway complications. Furthermore, a huge progress has been made in the management of such complications. Early diagnosis of bronchial complications and their prompt and correct management are crucial to achieve long-term survival.
Collapse
Affiliation(s)
- Marco Anile
- 1 University of Rome Sapienza, Rome, Italy ; 2 Department of Thoracic Surgery, Umberto I Hospital, Rome, Italy ; 3 Department of Thoracic Surgery, Sant'Andrea Hospital, Rome, Italy ; 4 Fondazione Eleonora Lorillard-Spencer-Cenci, Sapienza University, Rome, Italy
| | - Daniele Diso
- 1 University of Rome Sapienza, Rome, Italy ; 2 Department of Thoracic Surgery, Umberto I Hospital, Rome, Italy ; 3 Department of Thoracic Surgery, Sant'Andrea Hospital, Rome, Italy ; 4 Fondazione Eleonora Lorillard-Spencer-Cenci, Sapienza University, Rome, Italy
| | - Erino Angelo Rendina
- 1 University of Rome Sapienza, Rome, Italy ; 2 Department of Thoracic Surgery, Umberto I Hospital, Rome, Italy ; 3 Department of Thoracic Surgery, Sant'Andrea Hospital, Rome, Italy ; 4 Fondazione Eleonora Lorillard-Spencer-Cenci, Sapienza University, Rome, Italy
| | - Federico Venuta
- 1 University of Rome Sapienza, Rome, Italy ; 2 Department of Thoracic Surgery, Umberto I Hospital, Rome, Italy ; 3 Department of Thoracic Surgery, Sant'Andrea Hospital, Rome, Italy ; 4 Fondazione Eleonora Lorillard-Spencer-Cenci, Sapienza University, Rome, Italy
| |
Collapse
|
13
|
La ventilation non invasive en chirurgie pulmonaire. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Soh S, Park JH, Kim JM, Lee MJ, Koh SO, Paik HC, Park MS, Na S. Predicting Delayed Ventilator Weaning after Lung Transplantation: The Role of Body Mass Index. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.4.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sarah Soh
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Ha Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Min Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Shin Ok Koh
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Chae Paik
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Suk Park
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sungwon Na
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Liu N, Chazot T, Trillat B, Michel-Cherqui M, Marandon JY, Law-Koune JD, Rives B, Fischler M. Closed-Loop Control of Consciousness During Lung Transplantation: An Observational Study. J Cardiothorac Vasc Anesth 2008; 22:611-5. [DOI: 10.1053/j.jvca.2008.04.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Indexed: 11/11/2022]
|
16
|
Augoustides JG, Watcha SM, Pochettino A, Jobes DR. Early tracheal extubation in adults undergoing single-lung transplantation for chronic obstructive pulmonary disease: pilot evaluation of perioperative outcome. Interact Cardiovasc Thorac Surg 2008; 7:755-8. [PMID: 18628342 DOI: 10.1510/icvts.2008.182881] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The objective of this pilot study was to evaluate the safety and success of early tracheal extubation (ETE) as compared to delayed tracheal extubation (DTE) in single-lung transplantation (SLT) for chronic obstructive pulmonary disease (COPD). This retrospective observational study was undertaken at a university hospital. Fifty-seven adult patients who underwent SLT for COPD (1998-2003) were enrolled. The study cohort was divided into an ETE subgroup (tracheal extubation in the operating room) or a DTE subgroup (tracheal extubation in the intensive care unit). There were no significant differences in perioperative outcomes between subgroups (in-hospital mortality; length of stay; prolonged mechanical ventilation; primary graft dysfunction; pneumonia; atrial fibrillation; renal dysfunction; and, sepsis). The anesthetic technique associated with ETE in SLT for COPD was characterized by limited systemic anesthetics and perioperative thoracic epidural analgesia. Appropriate ETE in SLT for COPD is not only safe but also results in equivalent perioperative outcome when compared to the traditional technique of DTE. Future studies should be powered to examine whether ETE reduces native lung complications such as hyperinflation, pneumonia and pneumothorax.
Collapse
Affiliation(s)
- John G Augoustides
- Anesthesiology and Critical Care, 680 Dulles Building, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104-4283, USA.
| | | | | | | |
Collapse
|
17
|
Augoustides JGT. Independent lung ventilation in adult single-lung transplantation: Is it time for fast-track anesthesia and early tracheal extubation? J Thorac Cardiovasc Surg 2007; 134:825; author reply 825-6. [PMID: 17723864 DOI: 10.1016/j.jtcvs.2007.04.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Accepted: 04/12/2007] [Indexed: 10/22/2022]
|
18
|
Pilcher DV, Auzinger GM, Mitra B, Tuxen DV, Salamonsen RF, Davies AR, Williams TJ, Snell GI. Reply to the Editor. J Thorac Cardiovasc Surg 2007. [DOI: 10.1016/j.jtcvs.2007.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
19
|
Abstract
PURPOSE OF REVIEW Respiratory failure remains the most common complication in the perioperative period after lung transplantation. Consequently it is important to develop an approach to diagnosis and the treatment of respiratory failure in this population. This review highlights the advances made in the understanding and treatment of lung transplant patients in the early postoperative phase. Owing to its relative importance, advances in the understanding and treatment of ischaemia-reperfusion injury are highlighted. RECENT FINDINGS The causes of respiratory failure and the complications seen after transplantation are time dependent, with ischaemia-reperfusion, infection, technical problems and acute rejection being the most common in the early perioperative phase, and obliterative bronchiolitis, rejection, and infections secondary to bacteria, fungi, and viruses becoming more prevalent after 3 months. The advances in lung preservation and postoperative care may be overshadowed by an increase in the complexity of the recipients and the use of more marginal organs. An improved mechanistic understanding of ischaemia-reperfusion injury has translated into potential therapeutic targets. The development of prospective clinical trials, however, is hampered by a relatively small sample of patients and a significant degree of heterogeneity in the lung transplant population. SUMMARY Many advances have been made in the understanding of ischaemia-reperfusion injury. Owing to the acute and long-term implications of this complication, interventions that reduce the risk of developing ischaemia-reperfusion need to be evaluated in prospective clinical trials.
Collapse
Affiliation(s)
- John Granton
- Faculty of Medicine, University of Toronto, Pulmonary Hypertension Programme, Toronto General Hospital, Toronto, Ontario, Canada.
| |
Collapse
|