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Thompson TZ, Bobr A, Juskewitch JE, Winters JL. Therapeutic plasma exchange for steroid refractory idiopathic inflammatory myopathies with interstitial lung disease. J Clin Apher 2023; 38:481-490. [PMID: 36408807 DOI: 10.1002/jca.22034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/27/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Idiopathic inflammatory myopathies (IIMs) encompass many rheumatologic diseases characterized by inflammatory muscle disease, typically unified by proximal muscle weakness. A subset of patients with IIM present with interstitial lung disease (ILD) with identifiable antibodies such as in anti-synthetase syndrome (AS) with antibodies to aminoacyl-tRNA synthetases, and clinically amyopathic dermatomyositis (CADM) with anti-melanoma differentiation-associated protein 5 (MDA5). Recent case reports demonstrate response to therapeutic plasma exchange (TPE) or column filtration plasmapheresis in IIM with ILD resistant to medical management. We present our experience with eight patients with IIM with ILD undergoing TPE at a large US-based hospital system. PATIENT CHARACTERISTICS Eight patients with IIM with ILD were treated with TPE over the last 10 years. The therapy consisted of 5-7 one plasma volume exchanges every other day to daily. Seven of eight patients had identifiable antibodies. RESULTS Following completion of TPE, seven of eight demonstrated improvement in pulmonary function despite lack of improvement of pulmonary function with standard therapy. CONCLUSION In antibody-mediated, treatment refractory IIM with ILD, TPE may be a viable intervention. This is a disease for which the role of apheresis is evolving. CLINICAL TRIAL REGISTRATION Not application.
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Affiliation(s)
- Thomas Zachary Thompson
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Aleh Bobr
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Justin Eddie Juskewitch
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Jeffrey Lawrence Winters
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
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Eggleston RH, Baqir M, Varghese C, Pennington KM, Bekele DI, Hartman TE, Ernste FC. Clinical Outcomes With and Without Plasma Exchange in the Treatment of Rapidly Progressive Interstitial Lung Disease Associated With Idiopathic Inflammatory Myopathy. J Clin Rheumatol 2023; 29:151-158. [PMID: 36729874 DOI: 10.1097/rhu.0000000000001923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVE A subset of patients with idiopathic inflammatory myopathy (IIM) develops highly fatal, rapidly progressive interstitial lung disease (RP-ILD). Treatment strategies consist of glucocorticoid and adjunctive immunosuppressive therapies. Plasma exchange (PE) is an alternative therapy, but its benefit is unclear. In this study, we aimed to determine whether PE benefited outcomes for patients with RP-ILD. METHODS In this medical records review study, we compared baseline characteristics and clinical outcomes for 2 groups of patients with IIM-related RP-ILD: those who received and did not receive PE. RESULTS Our cohort consisted of 15 patients, 9 of whom received PE. Baseline demographic characteristics and severity of lung, skin, and musculoskeletal disease between the 2 groups of patients were not significantly different. Five patients required mechanical ventilation (2, PE; 3, no PE). Plasma exchange was generally a third-line adjunctive treatment option. The PE group had a longer median (interquartile range) hospitalization (27.0 [23.0-36.0] days) than the non-PE group (12.0 [8.0-14.0] days) ( p = 0.02). There was a potential benefit in 30-day mortality improvement in those receiving PE (0% vs 33%, p = 0.14), with a statistically significant improvement in 2 important composite end points including 30-day mortality or need for lung transplant (0% vs 50%, p = 0.04) and 1-year mortality or need for lung transplant or hospital readmission for RP-ILD in those receiving PE (22% vs 83%, p = 0.04). CONCLUSIONS Plasma exchange may be an underutilized, safe salvage therapy for patients with IIM-related RP-ILD when other immunosuppressive therapies fail.
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Affiliation(s)
- Reid H Eggleston
- From the Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science
| | - Misbah Baqir
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester
| | | | - Kelly M Pennington
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester
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Barreto JA, Mehta A, Thiagarajan RR, Hayward KN, Brogan A, Brogan TV. The Use of Extracorporeal Life Support in Children With Immune-Mediated Diseases. Pediatr Crit Care Med 2022; 23:e60-e65. [PMID: 34261943 DOI: 10.1097/pcc.0000000000002801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the use and outcomes of extracorporeal membrane oxygenation support among children with immune-mediated conditions. DESIGN Retrospective cohort study. SETTING The Extracorporeal Life Support Organization registry. PATIENTS Patients 1 month to 18 years old with International Classification of Diseases, 9th Edition and International Classification of Diseases, 10th Edition codes for immune-mediated conditions from 1989 to 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS During the study period, 207 patients with an immune-mediated condition received extracorporeal membrane oxygenation, and 50% survived to discharge. Most patients (63%) received extracorporeal membrane oxygenation for respiratory support with 53% survival, 21% received cardiac support (55% survival), and 15% received extracorporeal cardiopulmonary resuscitation (34% survival). The most common diagnosis among nonsurvivors was hemophagocytic lymphohistiocytosis/macrophage activation syndrome with 37% survival. Patients with juvenile idiopathic arthritis (23%) and dermatomyositis (25%) had the lowest survival. Nonsurvivors had a higher frequency of infections, neurologic complications, and renal replacement therapy use. Use of preextracorporeal membrane oxygenation corticosteroids was associated with mortality. CONCLUSIONS Children with immune-mediated conditions can be successfully supported with extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation use has increased over time, and survival varies considerably by diagnosis.
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Affiliation(s)
- Jessica A Barreto
- Department of Pediatrics, Division of Critical Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | - Amit Mehta
- Department of Pediatrics, Oregon Health and Sciences University, Portland, OR
| | - Ravi R Thiagarajan
- Department of Cardiology, Children's Hospital, Boston, Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kristen N Hayward
- Department of Pediatrics, Division of Rheumatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | | | - Thomas V Brogan
- Department of Pediatrics, Division of Critical Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
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Banuls L, Vanoverschelde J, Garnier F, Amalric M, Jaber S, Charbit J, Chalard K, Mourad M, Benchabane N, Benomar R, Besnard N, Daubin D, Brunot V, Klouche K, Larcher R. Interstitial Lung Disease Worsens Short- and Long-Term Outcomes of Systemic Rheumatic Disease Patients Admitted to the ICU: A Multicenter Study. J Clin Med 2021; 10:jcm10051037. [PMID: 33802364 PMCID: PMC7959321 DOI: 10.3390/jcm10051037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022] Open
Abstract
Critically ill patients with systemic rheumatic diseases (SRDs) have a fair prognosis, while those with interstitial lung disease (ILD) have a poorer outcome. However, the prognosis of SRD patients with ILD admitted to the intensive care unit (ICU) remains unclear. We conducted a case–control study to investigate the outcomes of critically ill SRD-ILD patients. Consecutive SRD-ILD patients admitted to five ICUs from January 2007 to December 2017 were compared to SRD patients without ILD. Mortality rates were compared between groups, and prognostic factors were then identified. One hundred and forty critically ill SRD patients were included in the study. Among the 70 patients with SRD–ILD, the SRDs were connective tissue diseases (56%), vasculitis (29%), sarcoidosis (13%), and spondylarthritis (3%). Patients were mainly admitted for acute exacerbation of SRD-ILD (36%) or infection (34%). ICU, in-hospital, and one-year mortality rates in SRD-ILD patients were higher than in SRD patients without ILD (n = 70): 40% vs. 16% (p < 0.01), 49% vs. 19% (p < 0.01), and 66% vs. 40% (p < 0.01), respectively. Hypoxemia, high sequential organ failure assessment (SOFA) score, and admission for ILD acute exacerbation were associated with ICU mortality. In conclusion, ILD worsened the outcomes of SRD patients admitted to the ICU. Admissions related to SRD-ILD acute exacerbation and the severity of the acute respiratory failure were associated with ICU mortality.
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Affiliation(s)
- Lorrain Banuls
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 191, avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.B.); (F.G.); (M.A.); (N.B.); (R.B.); (N.B.); (D.D.); (V.B.); (K.K.)
| | - Juliette Vanoverschelde
- Radiology Department, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 34090 Montpellier, France;
| | - Fanny Garnier
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 191, avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.B.); (F.G.); (M.A.); (N.B.); (R.B.); (N.B.); (D.D.); (V.B.); (K.K.)
| | - Matthieu Amalric
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 191, avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.B.); (F.G.); (M.A.); (N.B.); (R.B.); (N.B.); (D.D.); (V.B.); (K.K.)
| | - Samir Jaber
- Department of Anesthesiology and Critical Care, Saint Eloi Hospital, Montpellier University Hospital, 34090 Montpellier, France;
- PhyMedExp, University of Montpellier, INSERM (French Institut of Health and Medical Research), CNRS (French National Centre for Scientific Research), 34090 Montpellier, France;
| | - Jonathan Charbit
- Department of Anesthesiology and Critical Care, Lapeyronie Hospital, Montpellier University Hospital, 34090 Montpellier, France;
| | - Kevin Chalard
- Department of Anesthesiology and Critical Care, Gui de Chauliac Hospital, Montpellier University Hospital, 34090 Montpellier, France;
| | - Marc Mourad
- PhyMedExp, University of Montpellier, INSERM (French Institut of Health and Medical Research), CNRS (French National Centre for Scientific Research), 34090 Montpellier, France;
- Department of Anesthesiology and Critical Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital, 34090 Montpellier, France
| | - Nacim Benchabane
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 191, avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.B.); (F.G.); (M.A.); (N.B.); (R.B.); (N.B.); (D.D.); (V.B.); (K.K.)
- PhyMedExp, University of Montpellier, INSERM (French Institut of Health and Medical Research), CNRS (French National Centre for Scientific Research), 34090 Montpellier, France;
| | - Racim Benomar
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 191, avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.B.); (F.G.); (M.A.); (N.B.); (R.B.); (N.B.); (D.D.); (V.B.); (K.K.)
| | - Noemie Besnard
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 191, avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.B.); (F.G.); (M.A.); (N.B.); (R.B.); (N.B.); (D.D.); (V.B.); (K.K.)
| | - Delphine Daubin
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 191, avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.B.); (F.G.); (M.A.); (N.B.); (R.B.); (N.B.); (D.D.); (V.B.); (K.K.)
| | - Vincent Brunot
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 191, avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.B.); (F.G.); (M.A.); (N.B.); (R.B.); (N.B.); (D.D.); (V.B.); (K.K.)
| | - Kada Klouche
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 191, avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.B.); (F.G.); (M.A.); (N.B.); (R.B.); (N.B.); (D.D.); (V.B.); (K.K.)
- PhyMedExp, University of Montpellier, INSERM (French Institut of Health and Medical Research), CNRS (French National Centre for Scientific Research), 34090 Montpellier, France;
| | - Romaric Larcher
- Intensive Care Medicine Department, Lapeyronie Hospital, Montpellier University Hospital, 191, avenue du Doyen Gaston Giraud, 34090 Montpellier, France; (L.B.); (F.G.); (M.A.); (N.B.); (R.B.); (N.B.); (D.D.); (V.B.); (K.K.)
- PhyMedExp, University of Montpellier, INSERM (French Institut of Health and Medical Research), CNRS (French National Centre for Scientific Research), 34090 Montpellier, France;
- Correspondence:
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Wolfskeil M, Devriendt Y, Dumoulin A, Lormans P. Spontaneous pneumomediastinum in Covid-19 : a case of complete resolution despite invasive positive pressure ventilation. ACTA ANAESTHESIOLOGICA BELGICA 2021. [DOI: 10.56126/72.1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present the case of a 65-year-old patient who was admitted to the intensive care unit (ICU) due to Covid-19 respiratory failure. During his hospital stay, he developed a spontaneous pneumomediastinum (SP). To date, there have been few reports of SP associated with Covid-19 and even less is known about the impact of positive pressure ventilation on these patients.
Our patient was first treated with high-flow nasal cannula oxygen therapy (HFNC). Because of further respiratory deterioration, he was supported with non-invasive ventilation (NIV). Later, he required intubation and ventilation with invasive positive pressure ventilation. Despite this, a complete spontaneous resolution of the pneumomediastinum was observed 13 days after the initial diagnosis.
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Gao Y, Moua T. Treatment of the Connective Tissue Disease-Related Interstitial Lung Diseases: A Narrative Review. Mayo Clin Proc 2020; 95:554-573. [PMID: 32138882 DOI: 10.1016/j.mayocp.2019.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/27/2019] [Accepted: 07/16/2019] [Indexed: 11/20/2022]
Abstract
Interstitial lung disease (ILD) is a frequent complication of patients with connective tissue disease (CTD) and significantly affects morbidity and mortality. Disease course may vary from stable or mildly progressive to more severe, with rapid loss of lung function. We conducted a search of PubMed (National Library of Medicine) and the Web of Science Core Collection using the key words lung, pulmonary, pneumonia, pneumonitis, and alveolar and subtypes of CTD. All clinical studies from January 1, 1980, through September 1, 2018, were reviewed for descriptions of specific therapies and their efficacy or safety and were categorized as controlled interventional trials, observational prospective or retrospective cohort studies, case series (>5 patients), and case reports (<5 patients). Low-quality reports (<5 patients) before 2000, reviews, editorials, popular science papers, and letters to the editor without complete descriptions of the therapies used or their outcomes were excluded. Directed therapy for CTD-ILD is dominated by empirical use of immunosuppressive agents, with the decision to treat, treatment choice, and treatment duration limited to cases and cohort observations. Only a few higher-level controlled studies were available specifically in scleroderma-related ILD. We summarize herein for the clinician the published treatment scope and experience, highlighted clinical response, and common adverse reactions for the management of CTD-ILD.
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Affiliation(s)
- Yang Gao
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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