BACKGROUND:Prolonged invasive respiratory support and extracorporeal membrane oxygenation(ECMO)in patients requiring urgent lung transplantation(ULTx)present signifi cant challenges to clinical practice due to severe ...BACKGROUND:Prolonged invasive respiratory support and extracorporeal membrane oxygenation(ECMO)in patients requiring urgent lung transplantation(ULTx)present signifi cant challenges to clinical practice due to severe underlying diseases and complex conditions.The aim of the study was to report the clinical outcomes of patients who received ULTx and followed the perioperative rehabilitation protocol implemented in a lung transplant center.METHODS:A retrospective analysis was conducted in ULTx patients who required preoperative invasive mechanical ventilation(IMV)and ECMO between January 2018 and January 2023.Data were retrieved from electronic medical records at our lung transplant center.RESULTS:Fourteen patients(mean age 57.43±10.97 years;12 males,2 females)underwent ULTx with bridging ECMO and IMV.The mean body mass index was 23.94±3.33 kg/m²,and the mean Acute Physiology and Chronic Health Evaluation(APACHE)II score was 21.50±3.96.The Nutritional Risk Screening 2002(NRS 2002)scores were≥3.ULTx was performed after an 8.5-day waiting period(interquartile interval[IQR]5.0-26.5 d).Following the surgeries,the average lengths of ECMO and IMV were 1.0(IQR 1.0-2.0)d and 5.0(IQR 3.0-7.3)d,respectively.The total length of hospital stay was 60.1±30.8 d,with an average intensive care unit stay of 38.3±22.9 d and post-operative hospitalization stay of 45.8±26.1 d.Two patients died within 30 d after ULTx,with a 30-day survival rate of 85.71%.CONCLUSION:Patients receiving ULTx showed an acceptable short-term survival rate,validating the practicality and safety of the treatment protocols implemented in our center.展开更多
Objective To estimate the indications,operative technique,perioperative treatment,postoperative complications and the outcome of lung transplantation ( LTx) for end - stage pulmonary diseases. Methods The clinical dat...Objective To estimate the indications,operative technique,perioperative treatment,postoperative complications and the outcome of lung transplantation ( LTx) for end - stage pulmonary diseases. Methods The clinical data of 100 patients with end - stage lung diseases receiving LTx in our hospital were retrospectively ana-展开更多
Background： The factors affecting the outcome of patients referred for lung transplantation （LTx） still have not been investigated extensively. The aim of this study was to characterize the patient outcomes and ide...Background： The factors affecting the outcome of patients referred for lung transplantation （LTx） still have not been investigated extensively. The aim of this study was to characterize the patient outcomes and identify the prognostic factors for death while awaiting the LTx. Methods： From January 2003 to November 2013, the clinical data of 103 patients with end-stage lung disease that had been referred for LTx to Department of Thoracic Surgery, Shanghai Pulmonary Hospital were analyzed retrospectively. The relationship between predictors and survival was evaluated using the Kaplan-Meier method and the Cox proportional hazards model. Results： Twenty-five patients （24.3%） died while awaiting the LTx. Fifty patients （48.5%） underwent LTx, and 28 patients （27.2%） were still on the waitlist. Compared to the candidates with chronic obstructive puhnonary disease （COPD）, patients with idiopathic pulmonary fibrosis （IPF） had a higher mortality while awaiting the LTx （40.0% vs. 12.3%, P= 0.003）. Patients requiring mechanical ventilation （MV） had a higher mortality while waiting than others （50.0% vs. 20.2%, P = 0.038）. Two variables, using MV and IPF but not COPD as primary disease, emerged as significant independent risk factors for death on the waitlist （hazard ratio [HR] 56.048, 95% confidence interval [CI]： 3.935-798.263, P= 0.003 and MR = 14.859, 95% CI： 2.695 81.932, P= 0.002, respectively）. Conclusion： The type of end-stage lung disease, pulmonary hypertension, and MV may be distinctive prognostic factors for death while awaiting the LTx.展开更多
Lung transplantation has been performed internationally as an effective treatment for a variety of end-stage lung＇diseases. A great disparity between the supply of donor organs and the demand of potential recipients ...Lung transplantation has been performed internationally as an effective treatment for a variety of end-stage lung＇diseases. A great disparity between the supply of donor organs and the demand of potential recipients has resulted in longer waiting time and annual increases in deaths on the lung transplant waiting list. Living-donor lobar lung transplantation （LDLLT） has become an established strategy to deal with the shortage of cadaveric donors. Encouraged by Starnes et al and Date et al, we began to apply the operation to a critically ill patient with bronchopulmonary dysplasia （BPD） firstly at Shanghai Pulmonary Hospital in China.展开更多
Acute exacerbations of interstitial lung disease(AE-ILD)represent an acute,frequent and often highly morbid event in the disease course of ILD patients.Admission in the intensive care unit(ICU)is very common and the n...Acute exacerbations of interstitial lung disease(AE-ILD)represent an acute,frequent and often highly morbid event in the disease course of ILD patients.Admission in the intensive care unit(ICU)is very common and the need for mechanical ventilation arises early.While non-invasive ventilation has shown promise in staving off intubation in selected patients,it is unclear whether mechanical ventilation can alter the exacerbation course unless it is a bridge to lung transplantation.Risk stratification using clinical and radiographic findings,and early palliative care involvement,are important in ICU care.In this review,we discuss many of the pathophysiological aspects of AE-ILD and raise the hypothesis that ventilation strategies used in acute respiratory distress syndrome might be implemented in AE-ILD.We present possible decision-making and management algorithms that can be used by the intensivist when caring for these patients.展开更多
文摘BACKGROUND:Prolonged invasive respiratory support and extracorporeal membrane oxygenation(ECMO)in patients requiring urgent lung transplantation(ULTx)present signifi cant challenges to clinical practice due to severe underlying diseases and complex conditions.The aim of the study was to report the clinical outcomes of patients who received ULTx and followed the perioperative rehabilitation protocol implemented in a lung transplant center.METHODS:A retrospective analysis was conducted in ULTx patients who required preoperative invasive mechanical ventilation(IMV)and ECMO between January 2018 and January 2023.Data were retrieved from electronic medical records at our lung transplant center.RESULTS:Fourteen patients(mean age 57.43±10.97 years;12 males,2 females)underwent ULTx with bridging ECMO and IMV.The mean body mass index was 23.94±3.33 kg/m²,and the mean Acute Physiology and Chronic Health Evaluation(APACHE)II score was 21.50±3.96.The Nutritional Risk Screening 2002(NRS 2002)scores were≥3.ULTx was performed after an 8.5-day waiting period(interquartile interval[IQR]5.0-26.5 d).Following the surgeries,the average lengths of ECMO and IMV were 1.0(IQR 1.0-2.0)d and 5.0(IQR 3.0-7.3)d,respectively.The total length of hospital stay was 60.1±30.8 d,with an average intensive care unit stay of 38.3±22.9 d and post-operative hospitalization stay of 45.8±26.1 d.Two patients died within 30 d after ULTx,with a 30-day survival rate of 85.71%.CONCLUSION:Patients receiving ULTx showed an acceptable short-term survival rate,validating the practicality and safety of the treatment protocols implemented in our center.
文摘Objective To estimate the indications,operative technique,perioperative treatment,postoperative complications and the outcome of lung transplantation ( LTx) for end - stage pulmonary diseases. Methods The clinical data of 100 patients with end - stage lung diseases receiving LTx in our hospital were retrospectively ana-
基金the grants from the National Natural Science Foundation of China
文摘Background： The factors affecting the outcome of patients referred for lung transplantation （LTx） still have not been investigated extensively. The aim of this study was to characterize the patient outcomes and identify the prognostic factors for death while awaiting the LTx. Methods： From January 2003 to November 2013, the clinical data of 103 patients with end-stage lung disease that had been referred for LTx to Department of Thoracic Surgery, Shanghai Pulmonary Hospital were analyzed retrospectively. The relationship between predictors and survival was evaluated using the Kaplan-Meier method and the Cox proportional hazards model. Results： Twenty-five patients （24.3%） died while awaiting the LTx. Fifty patients （48.5%） underwent LTx, and 28 patients （27.2%） were still on the waitlist. Compared to the candidates with chronic obstructive puhnonary disease （COPD）, patients with idiopathic pulmonary fibrosis （IPF） had a higher mortality while awaiting the LTx （40.0% vs. 12.3%, P= 0.003）. Patients requiring mechanical ventilation （MV） had a higher mortality while waiting than others （50.0% vs. 20.2%, P = 0.038）. Two variables, using MV and IPF but not COPD as primary disease, emerged as significant independent risk factors for death on the waitlist （hazard ratio [HR] 56.048, 95% confidence interval [CI]： 3.935-798.263, P= 0.003 and MR = 14.859, 95% CI： 2.695 81.932, P= 0.002, respectively）. Conclusion： The type of end-stage lung disease, pulmonary hypertension, and MV may be distinctive prognostic factors for death while awaiting the LTx.
文摘Lung transplantation has been performed internationally as an effective treatment for a variety of end-stage lung＇diseases. A great disparity between the supply of donor organs and the demand of potential recipients has resulted in longer waiting time and annual increases in deaths on the lung transplant waiting list. Living-donor lobar lung transplantation （LDLLT） has become an established strategy to deal with the shortage of cadaveric donors. Encouraged by Starnes et al and Date et al, we began to apply the operation to a critically ill patient with bronchopulmonary dysplasia （BPD） firstly at Shanghai Pulmonary Hospital in China.
文摘Acute exacerbations of interstitial lung disease(AE-ILD)represent an acute,frequent and often highly morbid event in the disease course of ILD patients.Admission in the intensive care unit(ICU)is very common and the need for mechanical ventilation arises early.While non-invasive ventilation has shown promise in staving off intubation in selected patients,it is unclear whether mechanical ventilation can alter the exacerbation course unless it is a bridge to lung transplantation.Risk stratification using clinical and radiographic findings,and early palliative care involvement,are important in ICU care.In this review,we discuss many of the pathophysiological aspects of AE-ILD and raise the hypothesis that ventilation strategies used in acute respiratory distress syndrome might be implemented in AE-ILD.We present possible decision-making and management algorithms that can be used by the intensivist when caring for these patients.
