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Xuan C, Gu J, Chen J, Xu H. Respiratory compliance related to prognostic of lung transplant patients with veno‑venous extracorporeal membrane oxygenation support. Sci Rep 2025; 15:8421. [PMID: 40069322 PMCID: PMC11897404 DOI: 10.1038/s41598-025-93396-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 03/06/2025] [Indexed: 03/15/2025] Open
Abstract
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) plays an important role in the perioperative care of critically ill lung transplant patients. However, the factors predicting prognosis are unclear. This study assessed the association between static respiratory compliance (Crs) and outcomes of lung transplant patients receiving VV-ECMO in terms of 90-day mortality. Data were retrospectively collected for patients that underwent lung transplantation with VV-ECMO support during 2022-2023. Patients were divided into two groups according to the early postoperative Crs: lower Crs (Crs < 25 ml/cmH2O) and higher Crs (Crs ≥ 25 ml/cmH2O). Differences in patient characteristics and prognosis were then compared between the two groups. Receiver operating characteristic (ROC) curve analysis was used to evaluate the value of Crs for predicting 90-day mortality and univariate Cox proportional hazard model analysis was performed to estimate risk of Crs. Data were available for a total of 85 patients, including 50 (58.8%) patients in the higher Crs group and 35 (41.2%) patients in the lower Crs group. A lower Crs was significantly associated with a longer postoperative ECMO duration (hours, 42 vs. 24; P = 0.022), longer postoperative ventilator time (days, 3.7 vs. 2.0; P = 0.003), higher application of continuous renal replacement therapy (CRRT) (20.0% vs. 6.0%; P = 0.049), higher incidence of pneumonia (42.9% vs. 20.0%; P = 0.023), and higher 90-day mortality (22.9% vs. 6.0%; P = 0.023). The area under the curve of Crs for predicting 90-day mortality was 0.661 (P = 0.034). A higher Crs was a protective factor (hazard ratio = 0.925 [0.870-0.984)] P = 0.014). For lung transplant patients receiving VV-ECMO support, Crs < 25 ml/cmH2O is associated with more complications and higher 90-day mortality. As Crs is easily obtained at the bedside, it may be useful for predicting prognosis and guiding patient management.
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Affiliation(s)
- Chenhao Xuan
- Wuxi Medical Center, The Affiliated Wuxi People'S Hospital of Nanjing Medical University, Wuxi, 214023, Jiangsu, China
| | - Jingxiao Gu
- Wuxi Medical Center, The Affiliated Wuxi People'S Hospital of Nanjing Medical University, Wuxi, 214023, Jiangsu, China
| | - Jingyu Chen
- Wuxi Lung Transplant Center, The Affiliated Wuxi People'S Hospital of Nanjing Medical University, Wuxi, 214023, Jiangsu, China
| | - Hongyang Xu
- Wuxi Medical Center, The Affiliated Wuxi People'S Hospital of Nanjing Medical University, Wuxi, 214023, Jiangsu, China.
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Courtwright AM, Whyte AM, Devarajan J, Fritz AV, Martin AK, Wilkey B, Stollings L, Cassara CM, Tawil JN, Miltiades AN, Bottiger BA, Pollak AL, Boisen ML, Harika RS, Street C, Terracciano W, Green J, Subramani S, Gelzinis TA. The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2022 Part I: Lung Transplantation. J Cardiothorac Vasc Anesth 2024; 38:2516-2545. [PMID: 39256076 DOI: 10.1053/j.jvca.2024.04.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 09/12/2024]
Abstract
These highlights focus on the research in lung transplantation (LTX) that was published in 2022 and includes the assessment and optimization of candidates for LTX, donor optimization, the use of organs from donation after circulatory death, and outcomes when using marginal or novel donors; recipient factors affecting LTX, including age, disease, the use of extracorporeal life support; and special situations, such as coronavirus disease2019, pediatric LTX, and retransplantation. The remainder of the article focuses on the perioperative management of LTX, including the perioperative risk factors for acute renal failure (acute kidney injury); the incidence and management of phrenic nerve injury, delirium, and pain; and the postoperative management of hyperammonemia, early postoperative infections, and the use of donor-derived cell-free DNA to detect rejection.
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Affiliation(s)
- Andrew M Courtwright
- Department of Clinical Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Alice M Whyte
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | | | | | - Barbara Wilkey
- Department of Anesthesiology, University of Colorado, CO
| | - Lindsay Stollings
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Justin N Tawil
- Department of Anesthesiology, University of Wisconsin, WI
| | - Andrea N Miltiades
- Department of Anesthesiology, Columbia University Medical Center, New York, NY
| | - Brandi A Bottiger
- Associate Professor, Department of Anesthesiology, Duke University, Durham, NC
| | - Angela L Pollak
- Associate Professor, Department of Anesthesiology, Duke University, Durham, NC
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Ricky S Harika
- Department of Anesthesiology, Virginia Mason University, Seattle, WA
| | - Christina Street
- Department of Anesthesiology, Virginia Mason University, Seattle, WA
| | | | - Jeff Green
- Department of Anesthesiology, Virginia Mason University, Seattle, WA
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals & Clinics, Iowa City, IA
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Polastri M, Pehlivan E, Reed RM, Eden A. Postoperative conditions of rehabilitative interest in lung transplantation: a systematic review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2024; 41:235-251. [PMID: 39169532 PMCID: PMC11534411 DOI: 10.12701/jyms.2024.00521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 08/23/2024]
Abstract
Lung transplantation is an elective treatment option for end-stage respiratory diseases in which all medical therapy options have been exhausted. The current study aimed to identify updated information on the postoperative conditions that may impair rehabilitation after lung transplantation and to provide specific considerations of their clinical relevance during the recovery process. The present study is a systematic review conducted by searching three primary databases: the United States National Library of Medicine PubMed system, Scopus, and the Cochrane Library. The databases were searched for articles published from database inception until May 2024; at the end of the selection process, 27 documents were included in the final analysis. The retrieved material identified 19 conditions of rehabilitative interest that potentially affect the postoperative course: graft dysfunction, dysphagia, postsurgical pain, cognitive impairment, chronic lung allograft dysfunction-bronchiolitis obliterans syndrome, phrenic nerve injury, delayed extracorporeal membrane oxygenation weaning, airway clearance, refractory hypoxemia, mediastinitis, reduced oxidative capacity, sternal dehiscence, coronavirus disease 2019 (COVID-19), gastroparesis, ossification of the elbow, Takotsubo cardiomyopathy, airway dehiscence, recurrent pleural effusion, and scapular prolapse. Although some patients are not amenable to rehabilitation techniques, others can significantly improve with rehabilitation.
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Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Integration, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Esra Pehlivan
- Department of Physical Therapy and Rehabilitation, University of Health Sciences Turkey, Hamidiye Faculty of Health Sciences, Istanbul, Turkey
| | - Robert M. Reed
- Department of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Allaina Eden
- Department of Rehabilitation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Yang J, Xie X, Li J, Li Y, Li B, Wang C, Jiang P. Which strategy is better for lung transplantation: Cardiopulmonary bypass or extracorporeal membrane oxygenation? Perfusion 2024:2676591241242018. [PMID: 38557237 DOI: 10.1177/02676591241242018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background: In lung transplantation surgery, extracorporeal life support (ECLS) is essential for safety. Various support methods, including cardiopulmonary bypass (CPB) and off-pump techniques, are used, with extracorporeal membrane oxygenation (ECMO) gaining prominence. However, consensus on the best support strategy is lacking.Purpose: This article reviews risks, benefits, and outcomes of different support strategies in lung transplantation. By consolidating knowledge, it aims to clarify selecting the most appropriate ECLS modality.Research Design: A comprehensive literature review examined CPB, off-pump techniques, and ECMO outcomes in lung transplantation, including surgical results and complications.Study Sample: Studies, including clinical trials and observational research, focused on ECLS in lung transplantation, both retrospective and prospective, providing a broad evidence base.Data Collection and/or Analysis: Selected studies were analyzed for surgical outcomes, complications, and survival rates associated with CPB, off-pump techniques, and ECMO to assess safety and effectiveness.Results: Off-pump techniques are preferred, with ECMO increasingly vital as a bridge to transplant, overshadowing CPB. However, ECMO entails hidden risks and higher costs. While safer than CPB, optimizing ECMO postoperative use and monitoring is crucial for success.Conclusions: Off-pump techniques are standard, but ECMO's role is expanding. Despite advantages, careful ECMO management is crucial due to hidden risks and costs. Future research should focus on refining ECMO use and monitoring to improve outcomes, emphasizing individualized approaches for LT recipients.
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Affiliation(s)
- Jianbao Yang
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xinling Xie
- Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Jian Li
- Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Bin Li
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Cheng Wang
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Peng Jiang
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou, Gansu, China
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