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Azamar-Llamas D, Arenas-Martinez JS, Olivas-Martinez A, Jimenez JV, Kauffman-Ortega E, García-Carrera CJ, Papacristofilou-Riebeling B, Rivera-López FE, García-Juárez I. Impact of COVID-19 vaccination on liver transplant recipients. Experience in a reference center in Mexico. PLoS One 2024; 19:e0301198. [PMID: 38547193 PMCID: PMC10977796 DOI: 10.1371/journal.pone.0301198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/12/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND AND AIMS COVID-19 vaccination has proved to be effective to prevent symptomatic infection and severe disease even in immunocompromised patients including liver transplant patients. We aim to assess the impact of COVID-19 vaccination on the mortality and development of severe and critical disease in our center. METHODS A retrospective cohort study of LT patients in a reference center between March 2020 and February 2022. Demographic data, cirrhosis etiology, time on liver transplantation, immunosuppressive therapies, and vaccination status were recorded at the time of diagnosis. Primary outcome was death due to COVID-19, and secondary outcomes included the development of severe COVID-19 and intensive care unit (ICU) requirement. RESULTS 153 of 324 LT recipients developed COVID-19, in whom the main causes of cirrhosis were HCV infection and metabolic-associated fatty liver disease. The vaccines used were BNT162b2 (48.6%), ChAdOx1 nCoV-19 (21.6%), mRNA-1273 vaccine (1.4%), Sputnik V (14.9%), Ad5-nCoV-S (4.1%) and CoronaVac (9.5%). Case fatality and ICU requirement risk were similar among vaccinated and unvaccinated LT patients (adjusted relative case fatality for vaccinated versus unvaccinated of 0.68, 95% CI 0.14-3.24, p = 0.62; adjusted relative risk [aRR] for ICU requirement of 0.45, 95% CI 0.11-1.88, p = 0.27). Nonetheless, vaccination was associated with a lower risk of severe disease (aRR for severe disease of 0.32, 95% CI 0.14-0.71, p = 0.005). CONCLUSIONS Vaccination reduces the risk of severe COVID-19 in LT patients, regardless of the scheme used. Vaccination should be encouraged for all.
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Affiliation(s)
- Daniel Azamar-Llamas
- Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Antonio Olivas-Martinez
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - Jose Victor Jimenez
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut, United States of America
| | - Eric Kauffman-Ortega
- Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Cristian J García-Carrera
- Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Bruno Papacristofilou-Riebeling
- Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fabián E Rivera-López
- Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ignacio García-Juárez
- Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Costa DK, Yakusheva O, Khadr L, Ratliff HC, Lee KA, Sjoding M, Jimenez JV, Mariott DJ. Shift-Level Team Familiarity Is Associated with Improved Outcomes in Mechanically Ventilated Adults. Am J Respir Crit Care Med 2024. [PMID: 38358858 DOI: 10.1164/rccm.202310-1971oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/15/2024] [Indexed: 02/17/2024] Open
Abstract
RATIONALE Organizing intensive care unit (ICU) interprofessional teams is a high priority due to workforce needs, but the role of interprofessional familiarity remains unexplored. OBJECTIVE Determine if mechanically ventilated patients cared for by teams with greater familiarity have improved outcomes, such as lower mortality, shorter duration of mechanical ventilation (MV), and greater spontaneous breathing trial (SBT) implementation. METHODS We used electronic health records data of 5 ICUs in an academic medical center to map interprofessional teams and their ICU networks, measuring team familiarity as network coreness and mean team value. We used patient-level regression models to link team familiarity with patient outcomes, accounting for patient/unit factors. We also performed a split-sample analysis by using 2018 team familiarity data to predict 2019 outcomes. MEASUREMENTS Team familiarity was measured as the average number of patients shared by each clinician with all other clinicians in the ICU (i.e., coreness) and the average number of patients shared by any two members of the team (i.e., mean team value). MAIN RESULTS Among 4,485 encounters, unadjusted mortality was 12.9%, average duration of MV was 2.32 days and SBT implementation was 89%; average team coreness was 467.2 (SD = 96.15) and average mean team value was 87.02 (SD=42.42). A standard-deviation increase in team coreness was significantly associated with a 4.5% greater probability of SBT implementation, 23% shorter MV duration, and 3.8% lower probability of dying; mean team value was significantly associated with lower mortality. Split-sample results were attenuated but congruent in direction and interpretation. CONCLUSIONS Interprofessional familiarity was associated with improved outcomes; assignment models that prioritize familiarity might be a novel solution.
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Affiliation(s)
- Deena K Costa
- Yale School of Medicine, 12228, Yale School of Nursing, Orange, Connecticut, United States;
| | - Olga Yakusheva
- University of Michigan, School of Nursing, Ann Arbor, Michigan, United States
- University of Michigan, School of Public Health, Ann Arbor, Michigan, United States
| | - Lara Khadr
- University of Michigan School of Nursing, 16121, Ann Arbor, Michigan, United States
| | - Hannah C Ratliff
- University of Michigan, School of Nursing, Ann Arbor, Michigan, United States
| | - Kathryn A Lee
- University of Michigan School of Nursing, 16121, Ann Arbor, Michigan, United States
| | - Michael Sjoding
- University of Michigan, Internal Medicine Pulmonary Critical Care, Ann Arbor, Michigan, United States
| | - Jose Victor Jimenez
- Yale-New Haven Hospital, 25047, Internal Medicine, New Haven, Connecticut, United States
| | - Deanna J Mariott
- University of Michigan School of Nursing, 16121, Ann Arbor, Michigan, United States
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Jimenez JV, Ackrivo J, Hsu JY, Wilson MW, Labaki WW, Hansen-Flaschen J, Hyzy RC, Choi PJ. Lowering P CO2 With Noninvasive Ventilation Is Associated With Improved Survival in Chronic Hypercapnic Respiratory Failure. Respir Care 2023; 68:1613-1622. [PMID: 37137711 PMCID: PMC10676248 DOI: 10.4187/respcare.10813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/01/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Chronic hypercapnic respiratory failure is associated with high mortality. Although previous work has demonstrated a mortality improvement with high-intensity noninvasive ventilation in COPD, it is unclear whether a PCO2 reduction strategy is associated with improved outcomes in other populations of chronic hypercapnia. METHODS The objective of this study was to investigate the association between PCO2 reduction (by using transcutaneous PCO2 as an estimate for PaCO2 and survival in a broad population of individuals treated with noninvasive ventilation for chronic hypercapnia. We hypothesized that reductions in PCO2 would be associated with improved survival. Therefore, we performed a cohort study of all the subjects evaluated from February 2012 to January 2021 for noninvasive ventilation initiation and/or optimization due to chronic hypercapnia at a home ventilation clinic in an academic center. We used multivariable Cox proportional hazard models with time-varying coefficients and PCO2 as a time-varying covariate to test the association between PCO2 and all-cause mortality and when adjusting for known cofounders. RESULTS The mean ± SD age of 337 subjects was 57 ± 16 years, 37% women, and 85% white. In a univariate analysis, survival probability increased with reductions in PCO2 to < 50 mm Hg after 90 d, and these remained significant after adjusting for age, sex, race, body mass index, diagnosis, Charlson comorbidity index, and baseline PCO2 . In the multivariable analysis, the subjects who had a PaCO2 < 50 mm Hg had a reduced mortality risk of 94% between 90 and 179 d (hazard ratio [HR] 0.06, 95% CI 0.01-0.50), 69% between 180 and 364 d (HR 0.31, 95% CI 0.12-0.79), and 73% for 365-730 d (HR 0.27, 95% CI 0.13-0.56). CONCLUSIONS Reduction in PCO2 from baseline for subjects with chronic hypercapnia treated with noninvasive ventilation was associated with improved survival. Management strategies should target the greatest attainable reductions in PCO2 .
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Affiliation(s)
- Jose Victor Jimenez
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Jason Ackrivo
- Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jesse Y Hsu
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mathew W Wilson
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Wassim W Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - John Hansen-Flaschen
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Robert C Hyzy
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Philip J Choi
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan. Dr Jimenez is affiliated with the Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut.
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Jimenez JV, Hyzy RC. Electrical Impedance Tomography and Optimal Positive End-Expiratory Pressure: Uncovering Latent Heterogeneity of Treatment Effect. Am J Respir Crit Care Med 2023; 208:636-637. [PMID: 37387585 PMCID: PMC10492253 DOI: 10.1164/rccm.202305-0878le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/29/2023] [Indexed: 07/01/2023] Open
Affiliation(s)
- Jose Victor Jimenez
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut; and
| | - Robert C. Hyzy
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
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Jasso-Baltazar EA, Peña-Arellano GA, Aguirre-Valadez J, Ruiz I, Papacristofilou-Riebeling B, Jimenez JV, García-Carrera CJ, Rivera-López FE, Rodriguez-Andoney J, Lima-Lopez FC, Hernández-Oropeza JL, Díaz JAT, Kauffman-Ortega E, Ruiz-Manriquez J, Hernández-Reyes P, Zamudio-Bautista J, Rodriguez-Osorio CA, Pulido T, Muñoz-Martínez S, García-Juárez I. Portopulmonary Hypertension: An Updated Review. Transplant Direct 2023; 9:e1517. [PMID: 37492078 PMCID: PMC10365198 DOI: 10.1097/txd.0000000000001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 07/27/2023] Open
Abstract
Portal hypertension may have major consequences on the pulmonary vasculature due to the complex pathophysiological interactions between the liver and lungs. Portopulmonary hypertension (PoPH), a subset of group 1 pulmonary hypertension (PH), is a serious pulmonary vascular disease secondary to portal hypertension, and is the fourth most common subtype of pulmonary arterial hypertension. It is most commonly observed in cirrhotic patients; however, patients with noncirrhotic portal hypertension can also develop it. On suspicion of PoPH, the initial evaluation is by a transthoracic echocardiogram in which, if elevated pulmonary pressures are shown, patients should undergo right heart catheterization to confirm the diagnosis. The prognosis is extremely poor in untreated patients; therefore, management includes pulmonary arterial hypertension therapies with the aim of improving pulmonary hemodynamics and moving patients to orthotopic liver transplantation (OLT). In this article, we review in detail the epidemiology, pathophysiology, process for diagnosis, and most current treatments including OLT and prognosis in patients with PoPH. In addition, we present a diagnostic algorithm that includes the current criteria to properly select patients with PoPH who are candidates for OLT.
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Affiliation(s)
- Erick A. Jasso-Baltazar
- Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Gonzalo A. Peña-Arellano
- Department of Gastroenterology, Instituto de Seguridad Social del Estado de México y Municipios, Mexico State, Mexico
| | | | - Isaac Ruiz
- Departament of Hepatology and Liver Trasplantation, Centre Hospitalier de I´Universite of Montréal, Montreal, Canada
| | - Bruno Papacristofilou-Riebeling
- Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jose Victor Jimenez
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Cristian J. García-Carrera
- Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Fabián E. Rivera-López
- Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jesús Rodriguez-Andoney
- Pulmonary Circulation Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Francisco C. Lima-Lopez
- Cardiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Luis Hernández-Oropeza
- Pulmonary Circulation Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan A. Torres Díaz
- Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Eric Kauffman-Ortega
- Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jesus Ruiz-Manriquez
- Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Pablo Hernández-Reyes
- Cardiology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jorge Zamudio-Bautista
- Department of Anesthesiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A. Rodriguez-Osorio
- Department of Critical Care Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Tomás Pulido
- Cardiopulmonary Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - Ignacio García-Juárez
- Department of Gastroenterology and Liver Transplant Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Jimenez JV, Garcia-Tsao G, Saffo S. Emerging concepts in the care of patients with cirrhosis and septic shock. World J Hepatol 2023; 15:497-514. [PMID: 37206653 PMCID: PMC10190696 DOI: 10.4254/wjh.v15.i4.497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/19/2023] [Accepted: 03/23/2023] [Indexed: 04/20/2023] Open
Abstract
Septic shock impacts approximately 6% of hospitalized patients with cirrhosis and is associated with high rates of morbidity and mortality. Although a number of landmark clinical trials have paved the way for incremental improvements in the diagnosis and management of septic shock in the general population, patients with cirrhosis have largely been excluded from these studies and critical knowledge gaps continue to impact the care of these individuals. In this review, we discuss nuances in the care of patients with cirrhosis and septic shock using a pathophysiology-based approach. We illustrate that septic shock may be challenging to diagnose in this population in the context of factors such as chronic hypotension, impaired lactate metabolism, and concomitant hepatic encephalopathy. Furthermore, we demonstrate that the application of routine interventions such as intravenous fluids, vasopressors, antibiotics, and steroids should be carefully considered among those with decompensated cirrhosis in light of hemodynamic, metabolic, hormonal, and immunologic disturbances. We propose that future research should include and characterize patients with cirrhosis in a systematic manner, and clinical practice guidelines may need to be refined accordingly.
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Affiliation(s)
- Jose Victor Jimenez
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT 06520, United States
| | - Guadalupe Garcia-Tsao
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT 06520, United States
| | - Saad Saffo
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT 06520, United States.
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Jimenez JV, Banna S, Desai N. A Peculiar ST Elevation Mimicking STEMI. JAMA Intern Med 2023; 183:158-159. [PMID: 36574258 DOI: 10.1001/jamainternmed.2022.5070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This case report describes a patient in their 60s who presented to the emergency department with a 2-week history of shortness of breath and back pain exacerbated that morning.
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Affiliation(s)
- Jose Victor Jimenez
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Soumya Banna
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut
| | - Nihar Desai
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
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8
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Jimenez JV, Munroe E, Weirauch AJ, Fiorino K, Culter CA, Nelson K, Labaki WW, Choi PJ, Co I, Standiford TJ, Prescott HC, Hyzy RC. Electric impedance tomography-guided PEEP titration reduces mechanical power in ARDS: a randomized crossover pilot trial. Crit Care 2023; 27:21. [PMID: 36650593 PMCID: PMC9843117 DOI: 10.1186/s13054-023-04315-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In patients with acute respiratory distress syndrome undergoing mechanical ventilation, positive end-expiratory pressure (PEEP) can lead to recruitment or overdistension. Current strategies utilized for PEEP titration do not permit the distinction. Electric impedance tomography (EIT) detects and quantifies the presence of both collapse and overdistension. We investigated whether using EIT-guided PEEP titration leads to decreased mechanical power compared to high-PEEP/FiO2 tables. METHODS A single-center, randomized crossover pilot trial comparing EIT-guided PEEP selection versus PEEP selection using the High-PEEP/FiO2 table in patients with moderate-severe acute respiratory distress syndrome. The primary outcome was the change in mechanical power after each PEEP selection strategy. Secondary outcomes included changes in the 4 × driving pressure + respiratory rate (4 ΔP, + RR index) index, driving pressure, plateau pressure, PaO2/FiO2 ratio, and static compliance. RESULTS EIT was consistently associated with a decrease in mechanical power compared to PEEP/FiO2 tables (mean difference - 4.36 J/min, 95% CI - 6.7, - 1.95, p = 0.002) and led to lower values in the 4ΔP + RR index (- 11.42 J/min, 95% CI - 19.01, - 3.82, p = 0.007) mainly driven by a decrease in the elastic-dynamic power (- 1.61 J/min, - 2.99, - 0.22, p = 0.027). The elastic-static and resistive powers were unchanged. Similarly, EIT led to a statistically significant change in set PEEP (- 2 cmH2O, p = 0.046), driving pressure, (- 2.92 cmH2O, p = 0.003), peak pressure (- 6.25 cmH2O, p = 0.003), plateau pressure (- 4.53 cmH2O, p = 0.006), and static respiratory system compliance (+ 7.93 ml/cmH2O, p = 0.008). CONCLUSIONS In patients with moderate-severe acute respiratory distress syndrome, EIT-guided PEEP titration reduces mechanical power mainly through a reduction in elastic-dynamic power. Trial registration This trial was prospectively registered on Clinicaltrials.gov (NCT03793842) on January 4th, 2019.
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Affiliation(s)
- Jose Victor Jimenez
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA
| | - Elizabeth Munroe
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA
| | - Andrew J. Weirauch
- grid.214458.e0000000086837370UH/CVC Department of Respiratory Care, University of Michigan, Ann Arbor, MI USA
| | - Kelly Fiorino
- grid.214458.e0000000086837370UH/CVC Department of Respiratory Care, University of Michigan, Ann Arbor, MI USA
| | - Christopher A. Culter
- grid.214458.e0000000086837370UH/CVC Department of Respiratory Care, University of Michigan, Ann Arbor, MI USA
| | - Kristine Nelson
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA
| | - Wassim W. Labaki
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA
| | - Philip J. Choi
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA ,grid.214458.e0000000086837370UH/CVC Department of Respiratory Care, University of Michigan, Ann Arbor, MI USA
| | - Ivan Co
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA
| | - Theodore J. Standiford
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA
| | - Hallie C. Prescott
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA ,grid.497654.d0000 0000 8603 8958VA Center for Clinical Management Research, Ann Arbor, MI USA
| | - Robert C. Hyzy
- grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr. Floor 3 Reception C, Ann Arbor, MI 48109 USA
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Pérez-Escobar J, Jimenez JV, Rodríguez-Aguilar EF, Servín-Rojas M, Ruiz-Manriquez J, Safar-Boueri L, Carrillo-Maravilla E, Navasa M, García-Juárez I. Immunotolerance in liver transplantation: a primer for the clinician. Ann Hepatol 2023; 28:100760. [PMID: 36179797 DOI: 10.1016/j.aohep.2022.100760] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/08/2022] [Indexed: 02/04/2023]
Abstract
The use of immunosuppressive medications for solid organ transplantation is associated with cardiovascular, metabolic, and oncologic complications. On the other hand, the development of graft rejection is associated with increased mortality and graft dysfunction. Liver transplant recipients can withdraw from immunosuppression without developing graft injury while preserving an adequate antimicrobial response - a characteristic known as immunotolerance. Immunotolerance can be spontaneously or pharmacologically achieved. Contrary to the classic dogma, clinical studies have elucidated low rates of true spontaneous immunotolerance (no serologic or histological markers of immune injury) among liver transplant recipients. However, clinical, serologic, and tissue biomarkers can aid in selecting patients in whom immunosuppression can be safely withdrawn. For those who failed an immunosuppression withdrawal trial or are at high risk of rejection, pharmacological interventions for immunotolerance induction are under development. In this review, we provide an overview of the mechanisms of immunotolerance, the clinical studies investigating predictors and biomarkers of spontaneous immunotolerance, as well as the potential pharmacological interventions for inducing it.
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Affiliation(s)
- Juanita Pérez-Escobar
- Department of Hepatology and Liver Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jose Victor Jimenez
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Erika Faride Rodríguez-Aguilar
- Department of Hepatology and Liver Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Maximiliano Servín-Rojas
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jesus Ruiz-Manriquez
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Luisa Safar-Boueri
- Comprehensive Transplant Center, Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Eduardo Carrillo-Maravilla
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Miquel Navasa
- Liver Transplant Unit, Hepatology Service, Hospital Clínic de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Ignacio García-Juárez
- Department of Hepatology and Liver Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Jimenez JV, Sifuentes-Osornio J, Hyzy RC. Understanding the Impact of Intensive Care Unit Personnel on Intensive Care Unit Mortality during Times of High Demand. Ann Am Thorac Soc 2022; 19:1623-1624. [PMID: 35522445 PMCID: PMC9447386 DOI: 10.1513/annalsats.202203-231le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jose Victor Jimenez
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City, Mexico
- University of MichiganAnn Arbor, Michigan
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Affiliation(s)
| | - Jose Victor Jimenez
- Division Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor
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