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Yuriditsky E, Mitchell OJL, Moore WH, Sista AK, Brosnahan SB, Cruz R, Amoroso NE, Goldenberg RM, Smith DE, Jamin C, Maldonado TS, Horowitz JM. Reduced CT iodine perfusion score is associated with adverse clinical outcomes in acute pulmonary embolism. Vasc Med 2023; 28:59-61. [PMID: 36567600 DOI: 10.1177/1358863x221143818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Eugene Yuriditsky
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, USA
| | - Oscar J L Mitchell
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Center for Resuscitation Science, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Shari B Brosnahan
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Langone Health, New York, USA
| | - Rogelio Cruz
- Department of Medicine, NYU Langone Health, New York, USA
| | - Nancy E Amoroso
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Langone Health, New York, USA
| | - Ronald M Goldenberg
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, NYU Langone Health, New York, USA
| | - Deane E Smith
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, NYU Langone Health, New York, USA
| | - Catherine Jamin
- Department of Emergency Medicine, NYU Langone Health, New York, USA
| | - Thomas S Maldonado
- Department of Surgery, Division of Vascular and Endovascular Surgery, NYU Langone Health, New York, USA
| | - James M Horowitz
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, USA
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Bashir R, Foster M, Iskander A, Darki A, Jaber W, Rali PM, Lakhter V, Gandhi R, Klein A, Bhatheja R, Ross C, Natarajan K, Nanjundappa A, Angle JF, Ouriel K, Amoroso NE, Firth BG, Comerota AJ, Piazza G, Rosenfield K, Sista AK. Pharmacomechanical Catheter-Directed Thrombolysis With the Bashir Endovascular Catheter for Acute Pulmonary Embolism: The RESCUE Study. JACC Cardiovasc Interv 2022; 15:2427-2436. [PMID: 36121244 DOI: 10.1016/j.jcin.2022.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Catheter-directed thrombolysis (CDT) has been associated with rapid recovery of right ventricular (RV) function. The Bashir catheter was developed for enhanced thrombolysis in large vessels such as the pulmonary arteries (PAs) with lower doses of tissue plasminogen activator (tPA). OBJECTIVES The aim of this study was to evaluate the efficacy and safety of tPA infused using a pharmacomechanical (PM) CDT device called the Bashir endovascular catheter in patients with intermediate-risk acute pulmonary embolism (PE). METHODS Patients with symptoms of acute PE with computed tomographic evidence of RV dilatation were enrolled. The Bashir catheter was used to deliver 7 mg tPA into each PA over 5 hours. The primary efficacy endpoint was the core laboratory-assessed change in computed tomographic angiography-derived RV/left ventricular (LV) diameter ratio at 48 hours, and the primary safety endpoint was serious adverse events (SAEs) including major bleeding at 72 hours. RESULTS At 18 U.S. sites, 109 patients were enrolled. The median device placement time was 15 minutes. At 48 hours after PM-CDT, the RV/LV diameter ratio decreased by 0.56 (33.3%; P < 0.0001). PA obstruction as measured by the refined modified Miller index was reduced by 35.9% (P < 0.0001). One patient (0.92%) had 2 SAEs: a retroperitoneal bleed (procedure related) and iliac vein thrombosis (device related). Two other procedure-related SAEs were epistaxis and non-access site hematoma with anemia. CONCLUSIONS PM-CDT with the Bashir endovascular catheter is associated with a significant reduction in RV/LV diameter ratio and a very low rate of adverse events or major bleeding in patients with intermediate-risk acute PE. The notable finding was a significant reduction in PA obstruction with low-dose tPA. (Recombinant tPA by Endovascular Administration for the Treatment of Submassive PE Using CDT for the Reduction of Thrombus Burden [RESCUE]; NCT04248868).
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Affiliation(s)
- Riyaz Bashir
- Division of Cardiovascular Diseases, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA.
| | - Malcolm Foster
- Tennova Turkey Creek Medical Center, Knoxville, Tennessee, USA
| | - Ayman Iskander
- Division of Cardiology, St. Joseph's Hospital, Syracuse, New York, USA
| | - Amir Darki
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Wissam Jaber
- Department of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Parth M Rali
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Vladimir Lakhter
- Division of Cardiovascular Diseases, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Ripal Gandhi
- Miami Cardiac and Vascular Institute, Miami, Florida, USA
| | | | | | | | | | | | - John F Angle
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Nancy E Amoroso
- Division of Pulmonary, Critical Care and Sleep Medicine NYU Grossman School of Medicine, New York, New York, USA
| | | | - Anthony J Comerota
- Inova Heart and Vascular Institute, Inova Alexandria Hospital, Alexandria, Virginia, USA
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth Rosenfield
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Akhilesh K Sista
- Department of Radiology, Weill Cornell University School of Medicine, New York, New York, USA
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Fleitas Sosa D, Lehr AL, Zhao H, Roth S, Lakhther V, Bashir R, Cohen G, Panaro J, Maldonado TS, Horowitz J, Amoroso NE, Criner GJ, Brosnahan SB, Rali P. Impact of pulmonary embolism response teams on acute pulmonary embolism: a systematic review and meta-analysis. Eur Respir Rev 2022; 31:31/165/220023. [PMID: 35831010 DOI: 10.1183/16000617.0023-2022] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The impact of pulmonary embolism response teams (PERTs) on treatment choice and outcomes of patients with acute pulmonary embolism (PE) is still uncertain. OBJECTIVE To determine the effect of PERTs in the management and outcomes of patients with PE. METHODS PubMed, Embase, Web of Science, CINAHL, WorldWideScience and MedRxiv were searched for original articles reporting PERT patient outcomes from 2009. Data were analysed using a random effects model. RESULTS 16 studies comprising 3827 PERT patients and 3967 controls met inclusion criteria. The PERT group had more patients with intermediate and high-risk PE (66.2%) compared to the control group (48.5%). Meta-analysis demonstrated an increased risk of catheter-directed interventions, systemic thrombolysis and surgical embolectomy (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.74-2.53; p<0.01), similar bleeding complications (OR 1.10, 95% CI 0.88-1.37) and decreased utilisation of inferior vena cava (IVC) filters (OR 0.71, 95% CI 0.58-0.88; p<0.01) in the PERT group. Furthermore, there was a nonsignificant trend towards decreased mortality (OR 0.87, 95% CI 0.71-1.07; p=0.19) with PERTs. CONCLUSIONS The PERT group showed an increased use of advanced therapies and a decreased utilisation of IVC filters. This was not associated with increased bleeding. Despite comprising more severe PE patients, there was a trend towards lower mortality in the PERT group.
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Affiliation(s)
- Derlis Fleitas Sosa
- Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA .,Both authors contributed equally
| | - Andrew L Lehr
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA.,Both authors contributed equally
| | - Huaqing Zhao
- Dept of Clinical Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Stephanie Roth
- Biomedical and Research Services Librarian, Simmy and Harry Ginsburg Library, Temple University, Philadelphia, PA, USA
| | - Vlad Lakhther
- Dept of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Riyaz Bashir
- Dept of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Gary Cohen
- Dept of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Joseph Panaro
- Dept of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Thomas S Maldonado
- Division of Vascular Surgery, New York University Langone Health, New York, NY, USA
| | - James Horowitz
- Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Nancy E Amoroso
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA
| | - Gerard J Criner
- Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Shari B Brosnahan
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA
| | - Parth Rali
- Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Kwok B, Brosnahan SB, Amoroso NE, Goldenberg RM, Heyman B, Horowitz JM, Jamin C, Sista AK, Smith DE, Yuriditsky E, Maldonado TS. Pulmonary Embolism Response Team activation during the COVID-19 pandemic in a New York City Academic Hospital: a retrospective cohort analysis. J Thromb Thrombolysis 2021; 51:330-338. [PMID: 32910409 PMCID: PMC7482370 DOI: 10.1007/s11239-020-02264-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is associated with increased rates of deep vein thrombosis (DVT) and pulmonary embolism (PE). Pulmonary Embolism Response Teams (PERT) have previously been associated with improved outcomes. We aimed to investigate whether PERT utilization, recommendations, and outcomes for patients diagnosed with acute PE changed during the COVID-19 pandemic. This is a retrospective cohort study of all adult patients with acute PE who received care at an academic hospital system in New York City between March 1st and April 30th, 2020. These patients were compared against historic controls between March 1st and April 30th, 2019. PE severity, PERT utilization, initial management, PERT recommendations, and outcomes were compared. There were more cases of PE during the pandemic (82 vs. 59), but less PERT activations (26.8% vs. 64.4%, p < 0.001) despite similar markers of PE severity. PERT recommendations were similar before and during the pandemic; anticoagulation was most recommended (89.5% vs. 86.4%, p = 0.70). During the pandemic, those with PERT activations were more likely to be female (63.6% vs. 31.7%, p = 0.01), have a history of DVT/PE (22.7% vs. 1.7%, p = 0.01), and to be SARS-CoV-2 PCR negative (68.2% vs. 38.3% p = 0.02). PERT activation during the pandemic is associated with decreased length of stay (7.7 ± 7.7 vs. 13.2 ± 12.7 days, p = 0.02). PERT utilization decreased during the COVID-19 pandemic and its activation was associated with different biases. PERT recommendations and outcomes were similar before and during the pandemic, and led to decreased length of stay during the pandemic.
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Affiliation(s)
- Benjamin Kwok
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA.
| | - Shari B Brosnahan
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA
| | - Nancy E Amoroso
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA
| | - Ronald M Goldenberg
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA
| | - Brooke Heyman
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA
| | - James M Horowitz
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Catherine Jamin
- Ronald O. Perelman Department of Emergency Medicine, New York University Langone Health, New York, NY, USA
| | - Akhilesh K Sista
- Division of Vascular and Interventional Radiology, New York University Langone Health, New York, NY, USA
| | - Deane E Smith
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Eugene Yuriditsky
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Thomas S Maldonado
- Division of Vascular and Endovascular Surgery, New York University Langone Health, New York, NY, USA
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Yuriditsky E, Mitchell OJL, Sista AK, Xia Y, Sibley RA, Zhong J, Moore WH, Amoroso NE, Goldenberg RM, Smith DE, Brosnahan SB, Jamin C, Maldonado TS, Horowitz JM. Right ventricular stroke distance predicts death and clinical deterioration in patients with pulmonary embolism. Thromb Res 2020; 195:29-34. [PMID: 32652350 DOI: 10.1016/j.thromres.2020.06.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/13/2020] [Revised: 06/16/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The right ventricular outflow tract (RVOT) velocity time integral (VTI), an echocardiographic measure of stroke distance, correlates with cardiac index. We sought to determine the prognostic significance of low RVOT VTI on clinical outcomes among patients with acute pulmonary embolism (PE). MATERIALS AND METHODS We conducted a retrospective review of echocardiograms on Pulmonary Embolism Response Team (PERT) activations at our institution. The main outcome was a composite of death, cardiac arrest, or hemodynamic deterioration. RESULTS Of 188 patients, 30 met the combined outcome (16%) and had significantly lower RVOT VTI measurements (9.0 cm v 13.4 cm, p < 0.0001). The AUC for RVOT VTI at a cutoff of 10 cm was 0.78 (95% CI 0.67-0.90) with a sensitivity, specificity, negative predictive value, and positive predictive value of 0.72, 0.81, 0.94, and 0.42, respectively. Fifty-two patients of the cohort were classified as intermediate-high-risk PE and 21% of those met the combined outcome. RVOT VTI was lower among outcome positive patients (7.3 cm v 10.7 cm, p = 0.02). CONCLUSIONS Low RVOT VTI is associated with poor clinical outcomes among patients with acute PE.
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Affiliation(s)
- Eugene Yuriditsky
- Division of Cardiology, Department of Medicine, New York University School of Medicine, 530 First Ave. Skirball 9R, New York, NY 10016, United States of America.
| | - Oscar J L Mitchell
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, United States of America
| | - Akhilesh K Sista
- Department of Radiology, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Yuhe Xia
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, 180 Madison Ave, New York, NY 10016, United States of America
| | - Rachel A Sibley
- Department of Medicine, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Judy Zhong
- Division of Biostatistics, Department of Population Health, New York University School of Medicine, 180 Madison Ave, New York, NY 10016, United States of America
| | - William H Moore
- Department of Radiology, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Nancy E Amoroso
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Ronald M Goldenberg
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Deane E Smith
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Shari B Brosnahan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Catherine Jamin
- Department of Emergency Medicine, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - Thomas S Maldonado
- Division of Vascular and Endovascular Surgery, Department of Surgery, New York University School of Medicine, 424 E 34th St., New York, NY 10016, United States of America
| | - James M Horowitz
- Division of Cardiology, Department of Medicine, New York University School of Medicine, 530 First Ave. Skirball 9R, New York, NY 10016, United States of America
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Yuriditsky E, Mitchell OJ, Sibley RA, Xia Y, Sista AK, Zhong J, Moore WH, Amoroso NE, Goldenberg RM, Smith DE, Jamin C, Brosnahan SB, Maldonado TS, Horowitz JM. Low left ventricular outflow tract velocity time integral is associated with poor outcomes in acute pulmonary embolism. Vasc Med 2019; 25:133-140. [PMID: 31709912 DOI: 10.1177/1358863x19880268] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The left ventricular outflow tract (LVOT) velocity time integral (VTI) is an easily measured echocardiographic stroke volume index analog. Low values predict adverse outcomes in left ventricular failure. We postulate the left ventricular VTI may be a signal of right ventricular dysfunction in acute pulmonary embolism, and therefore a predictor of poor outcomes. We retrospectively reviewed echocardiograms on all Pulmonary Embolism Response Team activations at our institution at the time of pulmonary embolism diagnosis. Low LVOT VTI was defined as ⩽ 15 cm. We examined two composite outcomes: (1) in-hospital death or cardiac arrest; and (2) shock or need for primary reperfusion therapies. Sixty-one of 188 patients (32%) had a LVOT VTI of ⩽ 15 cm. Low VTI was associated with in-hospital death or cardiac arrest (odds ratio (OR) 6, 95% CI 2, 17.9; p = 0.0014) and shock or need for reperfusion (OR 23.3, 95% CI 6.6, 82.1; p < 0.0001). In a multivariable model, LVOT VTI ⩽ 15 remained significant for death or cardiac arrest (OR 3.48, 95% CI 1.02, 11.9; p = 0.047) and for shock or need for reperfusion (OR 8.12, 95% CI 1.62, 40.66; p = 0.011). Among intermediate-high-risk patients, low VTI was the only variable associated with the composite outcome of death, cardiac arrest, shock, or need for reperfusion (OR 14, 95% CI 1.7, 118.4; p = 0.015). LVOT VTI is associated with adverse short-term outcomes in acute pulmonary embolism. The VTI may help risk stratify patients with intermediate-high-risk pulmonary embolism.
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Affiliation(s)
- Eugene Yuriditsky
- Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Oscar Jl Mitchell
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Rachel A Sibley
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Yuhe Xia
- Department of Population Health, Division of Biostatistics, New York University School of Medicine, New York, NY, USA
| | - Akhilesh K Sista
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Judy Zhong
- Department of Population Health, Division of Biostatistics, New York University School of Medicine, New York, NY, USA
| | - William H Moore
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Nancy E Amoroso
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Ronald M Goldenberg
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Deane E Smith
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, New York University School of Medicine, New York, NY, USA
| | - Catherine Jamin
- Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA
| | - Shari B Brosnahan
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, New York University School of Medicine, New York, NY, USA
| | - Thomas S Maldonado
- Department of Surgery, Division of Vascular and Endovascular Surgery, New York University School of Medicine, New York, NY, USA
| | - James M Horowitz
- Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY, USA
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7
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Kazachkov M, Palma JA, Norcliffe-Kaufmann L, Bar-Aluma BE, Spalink CL, Barnes EP, Amoroso NE, Balou SM, Bess S, Chopra A, Condos R, Efrati O, Fitzgerald K, Fridman D, Goldenberg RM, Goldhaber A, Kaufman DA, Kothare SV, Levine J, Levy J, Lubinsky AS, Maayan C, Moy LC, Rivera PJ, Rodriguez AJ, Sokol G, Sloane MF, Tan T, Kaufmann H. Respiratory care in familial dysautonomia: Systematic review and expert consensus recommendations. Respir Med 2018; 141:37-46. [PMID: 30053970 PMCID: PMC6084453 DOI: 10.1016/j.rmed.2018.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/14/2018] [Accepted: 06/18/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Familial dysautonomia (Riley-Day syndrome, hereditary sensory autonomic neuropathy type-III) is a rare genetic disease caused by impaired development of sensory and afferent autonomic nerves. As a consequence, patients develop neurogenic dysphagia with frequent aspiration, chronic lung disease, and chemoreflex failure leading to severe sleep disordered breathing. The purpose of these guidelines is to provide recommendations for the diagnosis and treatment of respiratory disorders in familial dysautonomia. METHODS We performed a systematic review to summarize the evidence related to our questions. When evidence was not sufficient, we used data from the New York University Familial Dysautonomia Patient Registry, a database containing ongoing prospective comprehensive clinical data from 670 cases. The evidence was summarized and discussed by a multidisciplinary panel of experts. Evidence-based and expert recommendations were then formulated, written, and graded using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. RESULTS Recommendations were formulated for or against specific diagnostic tests and clinical interventions. Diagnostic tests reviewed included radiological evaluation, dysphagia evaluation, gastroesophageal evaluation, bronchoscopy and bronchoalveolar lavage, pulmonary function tests, laryngoscopy and polysomnography. Clinical interventions and therapies reviewed included prevention and management of aspiration, airway mucus clearance and chest physical therapy, viral respiratory infections, precautions during high altitude or air-flight travel, non-invasive ventilation during sleep, antibiotic therapy, steroid therapy, oxygen therapy, gastrostomy tube placement, Nissen fundoplication surgery, scoliosis surgery, tracheostomy and lung lobectomy. CONCLUSIONS Expert recommendations for the diagnosis and management of respiratory disease in patients with familial dysautonomia are provided. Frequent reassessment and updating will be needed.
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Affiliation(s)
- Mikhail Kazachkov
- Department of Pediatric Pulmonology, New York University School of Medicine, New York, NY, United States; Gastroesophageal, Upper Airway and Respiratory Diseases Center, New York University School of Medicine, New York, NY, United States
| | - Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, United States
| | - Lucy Norcliffe-Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, United States
| | - Bat-El Bar-Aluma
- Pediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel
| | - Christy L Spalink
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, United States
| | - Erin P Barnes
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, United States
| | - Nancy E Amoroso
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine. New York University School of Medicine, New York, NY, United States
| | - Stamatela M Balou
- Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, United States
| | - Shay Bess
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, United States
| | - Arun Chopra
- Department of Pediatrics, Division of Pediatric Critical Care, New York University School of Medicine, New York, NY, United States
| | - Rany Condos
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine. New York University School of Medicine, New York, NY, United States
| | - Ori Efrati
- Pediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel
| | - Kathryn Fitzgerald
- Department of Pediatric Pulmonology, New York University School of Medicine, New York, NY, United States
| | - David Fridman
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine. New York University School of Medicine, New York, NY, United States
| | - Ronald M Goldenberg
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine. New York University School of Medicine, New York, NY, United States
| | - Ayelet Goldhaber
- Department of Pediatrics, Pediatric Gastroenterology Unit, New York University School of Medicine, New York, NY, United States
| | - David A Kaufman
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine. New York University School of Medicine, New York, NY, United States
| | - Sanjeev V Kothare
- Department of Neurology, Pediatric Sleep Medicine Unit, New York University School of Medicine, New York, NY, United States
| | - Jeremiah Levine
- Department of Pediatrics, Pediatric Gastroenterology Unit, New York University School of Medicine, New York, NY, United States
| | - Joseph Levy
- Department of Pediatrics, Pediatric Gastroenterology Unit, New York University School of Medicine, New York, NY, United States
| | - Anthony S Lubinsky
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine. New York University School of Medicine, New York, NY, United States
| | - Channa Maayan
- Department of Pediatrics. Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Libia C Moy
- Department of Pediatrics, Pediatric Gastroenterology Unit, New York University School of Medicine, New York, NY, United States
| | - Pedro J Rivera
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine. New York University School of Medicine, New York, NY, United States
| | - Alcibiades J Rodriguez
- Department of Neurology, Sleep Laboratory, New York University School of Medicine, New York, NY, United States
| | - Gil Sokol
- Pediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Israel
| | - Mark F Sloane
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine. New York University School of Medicine, New York, NY, United States
| | - Tina Tan
- Gastroesophageal, Upper Airway and Respiratory Diseases Center, New York University School of Medicine, New York, NY, United States
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, NY, United States.
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