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Hoetzenecker K, Schwarz S, Keshavjee S, Cypel M. Lung transplantation for acute respiratory distress syndrome. J Thorac Cardiovasc Surg 2023; 165:1596-1601. [PMID: 35379475 DOI: 10.1016/j.jtcvs.2022.02.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/19/2022] [Accepted: 02/10/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Stefan Schwarz
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marcelo Cypel
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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2
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Frick AE, Gan CT, Vos R, Schwarz S, Kraft F, Kifjak D, Neyrinck AP, Van Raemdonck DE, Klepetko W, Jaksch P, Verschuuren EAM, Hoetzenecker K. Lung transplantation for acute respiratory distress syndrome: A multicenter experience. Am J Transplant 2022; 22:144-153. [PMID: 34254423 PMCID: PMC8441742 DOI: 10.1111/ajt.16759] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 01/25/2023]
Abstract
Acute respiratory distress syndrome (ARDS) is a rapidly progressive lung disease with a high mortality rate. Although lung transplantation (LTx) is a well-established treatment for a variety of chronic pulmonary diseases, LTx for acute lung failure (due to ARDS) remains controversial. We reviewed posttransplant outcome of ARDS patients from three high-volume European transplant centers. Demographics and clinical data were collected and analyzed. Viral infection was the main reason for ARDS (n = 7/13, 53.8%). All patients were admitted to ICU and required mechanical ventilation, 11/13 were supported with ECMO at the time of listing. They were granted a median LAS of 76 (IQR 50-85) and waited for a median of 3 days (IQR 1.5-14). Postoperatively, median length of mechanical ventilation was 33 days (IQR 17-52.5), median length of ICU and hospital stay were 39 days (IQR 19.5-58.5) and 54 days (IQR 43.5-127). Prolongation of peripheral postoperative ECMO was required in 7/13 (53.8%) patients with a median duration of 2 days (IQR 2-7). 30-day mortality was 7.7%, 1 and 5-year survival rates were calculated as 71.6% and 54.2%, respectively. Given the lack of alternative treatment options, the herein presented results support the concept of offering live-saving LTx to carefully selected ARDS patients.
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Affiliation(s)
- Anna E. Frick
- Department of Thoracic SurgeryMedical University of ViennaViennaAustria,Department of Cardiovascular SciencesKU LeuvenLeuvenBelgium
| | - Christiaan T. Gan
- Department of Pulmonary DiseasesUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Robin Vos
- BREATHELeuven Lung Transplant UnitDepartment of Chronic Diseases, Metabolism and Ageing (Chromed)KU LeuvenLeuvenBelgium,Department of Respiratory DiseasesUniversity Hospitals LeuvenLeuvenBelgium
| | - Stefan Schwarz
- Department of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Felix Kraft
- Department of Anaesthesia, General Intensive Care and Pain ManagementMedical University of ViennaViennaAustria
| | - Daria Kifjak
- Department of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
| | | | - Dirk E. Van Raemdonck
- BREATHELeuven Lung Transplant UnitDepartment of Chronic Diseases, Metabolism and Ageing (Chromed)KU LeuvenLeuvenBelgium,Department of Thoracic SurgeryUniversity Hospitals LeuvenLeuvenBelgium
| | - Walter Klepetko
- Department of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Peter Jaksch
- Department of Thoracic SurgeryMedical University of ViennaViennaAustria
| | - Erik A. M. Verschuuren
- Department of Pulmonary DiseasesUniversity Medical Centre GroningenGroningenThe Netherlands
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3
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Gottlieb J, Lepper PM, Berastegui C, Montull B, Wald A, Parmar J, Magnusson JM, Schönrath F, Laisaar T, Michel S, Larsson H, Vos R, Haneya A, Sandhaus T, Verschuuren E, le Pavec J, Tikkanen J, Hoetzenecker K. Lung transplantation for acute respiratory distress syndrome - a retrospective European Cohort Study. Eur Respir J 2021; 59:13993003.02078-2021. [PMID: 34824051 DOI: 10.1183/13993003.02078-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/27/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND The published experience of lung transplantation (LTX) in acute respiratory distress syndrome (ARDS) is limited. The aim of this study was to investigate the contemporary results of LTX attempts in ARDS in major European centers. METHODS We conducted a retrospective multicenter cohort study of all patients listed for LTX between 2011 and 2019. We surveyed 68 centers in 22 European countries. All patients admitted to the waitlist for lung transplantation with a diagnosis of "ARDS//pneumonia" were included. Patients without extracorporeal membrane oxygenation (ECMO) or mechanical ventilation were excluded. Patients were followed until October 1st 2020 or death. Multivariable analysis for 1-year survival after listing and lung transplantation were performed. RESULTS Forty-eight centers (74%) with a total transplant activity of 12 438 lung transplants during the 9-year period gave feedback. Forty patients with a median age of 35 years were identified. Patients were listed for LTX in 18 different centers in 10 countries. Thirty-one-patients underwent LTX (0·25% of all indications) and 9 patients died on the waitlist. Ninety percent of transplanted patients were on ECMO in combination with mechanical ventilation before LTX. On multivariable analysis, transplantation during 2015 until 2019 was independently associated with better 1-year survival after LTX (odds ratio 10.493, 95% CI 1.977, 55.705, p=0.006). Sixteen survivors out of 23 patients with known status (70%) returned to work after LTX. CONCLUSION LTX in highly selected ARDS patients is feasible and outcome has improved in the modern era. The selection process remains ethically and technically challenging.
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Affiliation(s)
- Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hanover, Germany .,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Philipp M Lepper
- Dept. of Internal Medicine V - Pneumology, Allergology and Critical Care Medicine, University Hospital of Saarland, and Saarland University, Homburg, Germany
| | - Cristina Berastegui
- Department of Respiratory Medicine, Lung Transplant Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Beatriz Montull
- Department of Respiratory Medicine and Lung Transplant Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Alexandra Wald
- Department of Pneumology, University Hospital Leipzig, Leipzig, Germany
| | - Jasvir Parmar
- Department of Respiratory Medicine, Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Jesper M Magnusson
- Department of respiratory medicine, Institute of Medicine, University of Gothenburg, Transplant Institue, Sahlgrenska university hospital
| | - Felix Schönrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Tanel Laisaar
- Department of Thoracic Surgery and Lung Transplantation, Lung Clinic, Tartu University Hospital; Lung Clinic, Tartu University
| | - Sebastian Michel
- Department of Cardiac Surgery, Ludwig Maximilian University Munich and Comprehensive Pneumology Center (CPC)-Munich, Member of the German Center for Lung Research (DZL)
| | - Hillevi Larsson
- Departement of Respiratory Medicine and Allergology, Skåne University Hospital, Lund, Sweden
| | - Robin Vos
- Department of Respiratory Diseases, University Hospitals Leuven - Campus Gasthuisberg, Leuven, Belgium.,Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Assad Haneya
- Department of Cardiac and Vascular Surgery, Campus Kiel, University-Medical-Center Schleswig-Holstein, Kiel, Germany
| | - Tim Sandhaus
- Department of Cardiovascular Surgery, University Hospital Jena, Jena, Germany
| | - Erik Verschuuren
- University Medical Center Groningen, Respiratory diseases, and Lung Transplantation, Groningen, The Netherlands
| | - Jérôme le Pavec
- Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Jussi Tikkanen
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Both authors contributed equally
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Austria.,Both authors contributed equally
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4
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Glorion M, De Wolf J, Zuber B, Cassiano F, Preau S, Brun AL, Cohen J, Tachon G, Neuville M, Brugière O, Picard C, Beaumont-Azuar L, Fessler J, Jacqmin S, Pricopi C, Chapelier A, Cuquemelle E, Parquin F, Magnan A, Roux A, Le Guen M, Sage E, Cerf C. Lung transplantation for COVID-19-associated acute respiratory distress syndrome: The first French patient. Respir Med Res 2021; 80:100851. [PMID: 34433119 PMCID: PMC8349363 DOI: 10.1016/j.resmer.2021.100851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/01/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023]
Affiliation(s)
- M Glorion
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
| | - J De Wolf
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - B Zuber
- Department of Intensive Care, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - F Cassiano
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - S Preau
- Department of Intensive Care, Salengro Hospital Lille CHU Avenue du Professeur Emile Laine, 59037 Lille, France
| | - A L Brun
- Department of radiology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - J Cohen
- Department of Pathology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - G Tachon
- Department of Intensive Care, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - M Neuville
- Department of Intensive Care, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - O Brugière
- Department of Pneumology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - C Picard
- Department of Pneumology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - L Beaumont-Azuar
- Department of Pneumology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - J Fessler
- Department of Anaesthesiology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - S Jacqmin
- Department of Anaesthesiology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - C Pricopi
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - A Chapelier
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - E Cuquemelle
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - F Parquin
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - A Magnan
- Department of Pneumology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - A Roux
- Department of Pathology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - M Le Guen
- Department of Anaesthesiology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - E Sage
- Department of Thoracic Surgery, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - C Cerf
- Department of Anaesthesiology, Hôpital Foch, 92150 Suresnes, France and Université Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France
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Beeckmans H, Bos S, Vos R. Selection Criteria for Lung Transplantation: Controversies and New Developments. Semin Respir Crit Care Med 2021; 42:329-345. [PMID: 34030197 DOI: 10.1055/s-0041-1728756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Lung transplantation is an accepted therapeutic option for end-stage lung diseases. The imbalance between limited availability and vast need of donor organs necessitates careful selection of recipient candidates, ensuring the best possible utilization of the scarce resource of organs. Nonetheless, possible lung transplant candidates who could experience a meaningful improvement in survival and quality of life should not be excluded solely based on the complexity of their case. In this review, controversial issues or difficult limitations for lung transplantation, and new developments in recipient selection criteria, are discussed, which may help broaden recipient eligibility for lung transplantation without compromising long-term outcomes.
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Affiliation(s)
- Hanne Beeckmans
- Division of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Saskia Bos
- Division of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Division of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), BREATHE, Leuven, Belgium
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6
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Harano T, Ryan JP, Chan EG, Noda K, Morrell MR, Luketich JD, Sanchez PG. Lung transplantation for the treatment of irreversible acute respiratory distress syndrome. Clin Transplant 2020; 35:e14182. [PMID: 33280169 PMCID: PMC7883278 DOI: 10.1111/ctr.14182] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/21/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite advances in critical care for acute respiratory distress syndrome (ARDS), some survivors in the acute phase are unable to wean from extracorporeal membrane oxygenation (ECMO) or mechanical ventilation. To date, little is known regarding whether lung transplantation confers a survival benefit for irreversible ARDS. METHODS This retrospective study was conducted using the United Network for Organ Sharing database (May 2005-December 2018). Patients with restrictive lung disease were divided into two groups: patients with and without ARDS. Propensity score matching identified recipients without ARDS for the control group. RESULTS A total of 63 patients with ARDS were waitlisted for lung transplantation, while 39 received a lung transplant after a median waitlist duration of 8 days. Seventy-eight patients were matched as controls. In the ARDS group, the median age was 30 years, and the median lung allocation score was 88.4. Among the 39 recipients, 30 (76.9%) received ECMO support prior to transplantation. Lung transplantation for ARDS and restrictive lung disease showed similar 90-day (87.2% vs. 88.5%, p = .80), 1-year (82.1% vs. 85.9%, p = .52), and 3-year (69.2% vs. 65.4%, p = .94) survival rates. CONCLUSIONS Lung transplantation provides acceptable outcomes in selected patients with irreversible ARDS.
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Affiliation(s)
- Takashi Harano
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John P Ryan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ernest G Chan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kentaro Noda
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Matthew R Morrell
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - James D Luketich
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Pablo G Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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7
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Abstract
BACKGROUND Lung transplantation (LTPL) is considered as a salvage therapeutic option in patients with end-stage lung disease. However, there is a lack of sufficient data on the use of LTPL in patients with acute respiratory distress syndrome (ARDS). Although there are few case reports on lung transplant for ARDS, no case series exists up to date. The aim of this study was to evaluate the clinical outcomes of patients with ARDS in accordance with the LTPL status. METHODS Patients who had severe ARDS (PaO2/FiO2 ratio ≤ 100 mm Hg with positive end-expiratory pressure ≥ 5 cm H2O) and were listed for LTPL with no underlying end-stage lung disease were included in this single-center retrospective study. Demographic and clinical data of the patients were collected and analyzed. RESULTS Fourteen patients were listed for LTPL due to severe ARDS. All patients received mechanical ventilation, and 12 (86%) patients underwent extracorporeal membrane oxygenation. Of the 9 patients who underwent LTPL, 8 (89%) survived, whereas only 1 (20%) patient out of those who did not receive LTPL survived. The median survival time of the patients who underwent LTPL was 1996 days (interquartile range [IQR], 872-2239), compared with 49 days (IQR, 872-2239) in patients who did not undergo LTPL. The median survival time after LTPL was 64 months (IQR, 28-72). The 3-year survival rate of the recipients was 78%. CONCLUSIONS LTPL may be considered as a therapeutic option in a select group of patients with severe ARDS. However, the irreversibility of the patient's lung status should be considered.
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8
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Gottlieb J, Greer M. Recent advances in extracorporeal life support as a bridge to lung transplantation. Expert Rev Respir Med 2018; 12:217-225. [PMID: 29369703 DOI: 10.1080/17476348.2018.1433035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Invasive mechanical respiratory support in candidate bridging to transplant (BTT) has become common practice in recent years. This usually consists of mechanical ventilation, extracorporeal life support (ECLS) or a combination of both techniques. Areas covered: This review covers epidemiology, technical considerations, indications and outcome of ELCS as BTT. Published literature was identified by searching the MEDLINE bibliographic database (1946-present) and appropriate papers were reviewed. In a retrospective analysis of the period 2010-2016 (n = 92 cases of ECLS bridging, 62% ECLS only) at our institution, bridging success was 73%, with 1-year survival among patients surviving to transplant 78%, surpassing our previously published results between 2005-2009 (bridging success 58%, 1-year survival 58%, p = 0.002 and p = 0.02, respectively). Expert commentary: While ECLS success has influenced lung transplant selection criteria, bridging remains technically and ethically challenging. Candidate selection and organ allocation are crucial to achieving acceptable results.
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Affiliation(s)
- Jens Gottlieb
- a Department of Respiratory Medicine , Hannover Medical School , Hannover , Germany.,b Biomedical Research in End-stage and Obstructive Disease , German Centre for Lung Research , Hannover , Germany
| | - Mark Greer
- a Department of Respiratory Medicine , Hannover Medical School , Hannover , Germany.,b Biomedical Research in End-stage and Obstructive Disease , German Centre for Lung Research , Hannover , Germany
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9
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Wiesen J, Joshi D, Guzman JA, Duggal A. Critical illness associated with 2013-2014 influenza A (H1N1): Postpandemic characteristics, presentation and outcomes. Indian J Crit Care Med 2016; 19:636-41. [PMID: 26730113 PMCID: PMC4687171 DOI: 10.4103/0972-5229.169328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: The United States experienced a postpandemic outbreak of H1N1 influenza in 2013–2014. Unlike the pandemic in 2009 clinical course and outcomes associated with critical illness in this postpandemic outbreak has been only sparsely described. Methods: We conducted a retrospective analysis of all patients admitted to the Medical Intensive Care Unit with H1N1 influenza infection in 2009–2010 (pandemic) and 2013–2014 (postpandemic). Results: Patients admitted in the postpandemic period were older (55 ± 13 vs. 45 ± 12, P = 0.002), and had a higher incidence of underlying pulmonary (17 vs. 7, P = 0.0007) and cardiac (16 vs. 8, P = 0.005) disease. Mechanical ventilation was initiated in most patients in both groups (27 vs. 21, P = 1.00). The PaO2/FiO2 ratio was significantly higher in the pandemic group on days 1 (216 vs. 81, P = 0.0009), 3 (202 ± 99 vs. 100 ± 46, P = 0.002) and 7 (199 ± 103 vs. 113 ± 44, P = 0.019) but by day 14 no difference was seen between the groups. Rescue therapies were used in more patients in the postpandemic period (48% vs. 20%, P = 0.028), including more frequent use of prone ventilation (10 vs. 3, P = 0.015), inhaled vasodilator therapy (11 vs. 4, P = 0.015) and extracorporeal membrane oxygenation (ECMO) (4 vs. 2, P = NS). No significant differences in mortality were seen between the two cohorts. Conclusions: Compared to the 2009–2010 pandemic, the 2013–2014 H1N1 strain affected older patients with more underlying co-morbid cardio-pulmonary diseases. The patients had worse oxygenation indices and rescue modalities such as prone ventilation, inhaled epoprostenol and ECMO, were used more consistently as compared to the 2009 pandemic.
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Affiliation(s)
- Jonathan Wiesen
- Department of Pulmonary Critical Care, Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, USA
| | - Dhruv Joshi
- Department of Pulmonary Critical Care, Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, USA
| | - Jorge A Guzman
- Department of Pulmonary Critical Care, Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, USA
| | - Abhijit Duggal
- Department of Pulmonary Critical Care, Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, USA
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10
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Chang Y, Lee SO, Shim TS, Choi SH, Kim HR, Kim YH, Kim DK, Park SI, Hong SB. Lung Transplantation in Acute Respiratory Distress Syndrome Caused by Influenza Pneumonia. Korean J Crit Care Med 2015. [DOI: 10.4266/kjccm.2015.30.3.196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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11
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Bur A, Wagner A, Röggla M, Berzlanovic A, Herkner H, Sterz F, Laggner AN. Fatal pulmonary edema after nitric acid inhalation. Resuscitation 1997; 35:33-6. [PMID: 9259058 DOI: 10.1016/s0300-9572(97)00029-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report a case of acute inhalation injury of nitric acid in a 56-year old white male. The patient presented conscious and dyspnoic at the emergency department after cleaning a copper chandelier with nitric acid. He had to be intubated 2 h after admission and mechanically ventilated because of fulminant respiratory insufficiency. As all sources of mechanical ventilation failed, extracorporeal membrane oxygenation had to be established 7 h after admission. With the additional use of surfactant and low dose inhalation therapy with nitric oxide (NO), the patient could be stabilised for 3 days and lung function improved temporarily. Despite all efforts the patient died at the fourth day from refactory respiratory failure. Pathologic examination revealed massive pulmonary edema without signs of inflammation. Thus, nitric acid inhalation induced pulmonary edema appears to be a most severe situation in which even most modern therapeutic interventions fail. As, in respect of recent literature and our case no promising therapy for nitric acid inhalation pulmonary edema is available, our efforts have to be directed towards prevention of nitric acid exposure.
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Affiliation(s)
- A Bur
- Department of Emergency Medicine, Vienna General Hospital, University Clinics, Austria
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12
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13
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Abstract
ARDS is a complex response of the lung to direct (inhalational) and indirect (hematogenous) insults. It is easy to be pessimistic about the benefit of the approaches we have described, but there is evidence that overall survival has improved in recent years. To maintain this progress, new therapies for ARDS must be rigorously evaluated, and their routine use should be recommended only after careful scrutiny of the evidence. Such a course will eliminate the unnecessary risks and costs often associated with unproved therapies.
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Affiliation(s)
- M H Kollef
- Department of Internal Medicine, Washington University Medical School, St. Louis, MO 63110
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14
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Abstract
Drug-induced disease of any system or organ can be associated with high morbidity and mortality, and it is tremendously costly to the health care of our country. More than 100 medications are known to affect the lungs adversely, including the airways in the form of cough and asthma, the interstitium with interstitial pneumonitis and noncardiac pulmonary edema, and the pleura with pleural effusions. Patients commonly do not even know what medications they are taking, do not bring them to the physician's office for identification, and usually do not relate over-the-counter medications with any problems they have. They assume that all nonprescription drugs are safe. Patients also believe that if they are taking prescription medications at their discretion, meaning on an as-needed basis, then these medications are also not important. This situation stresses just how imperative it is for the physician to take an accurate drug history in all patients seen with unexplained medical situations. Cardiovascular drugs that most commonly produce a pulmonary abnormality are amiodarone, the angiotensin-converting enzyme inhibitors, and beta-blockers. Pulmonary complications will develop in 6% of patients taking amiodarone and 15% taking angiotensin-converting enzyme inhibitors, with the former associated with interstitial pneumonitis that can be fatal and the latter associated with an irritating cough that is not associated with any pathologic or physiologic sequelae of consequence. The beta-blockers can aggravate obstructive lung disease in any patient taking them. Of the antiinflammatory agents, acetylsalicyclic acid can produce several different airway and parenchymal complications, including aggrevation of asthma in up to 5% of patients with asthma, a noncardiac pulmonary edema when levels exceed 40 mg/dl, and a pseudosepsis syndrome. More than 200 products contain aspirin. Low-dose methotrexate is proving to be a problem because granulomatous interstitial pneumonitis develops in 5% of those patients receiving it. This condition occurs most often in patients receiving the drug for rheumatoid arthritis, but it has been reported in a few patients receiving it for refractory asthma. Chemotherapeutic drug-induced lung disease is almost always associated with fever, thus mimicking opportunistic infection, which is the most common cause of pulmonary complications in the immunocompromised host. However, in 10% to 15% of patients, the pulmonary infiltrate is due to an adverse effect from a chemotherapeutic agent. This complication is frequently fatal even when recognized early.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- E C Rosenow
- Division of Pulmonary Diseases, Mayo Clinic, Rochester, Minnesota
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