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Eltonsy AM, Amlani K, Schleicher M, McCurry KR, Mehta AC. Diaphragmatic palsy following lung transplantation. Eur Respir Rev 2024; 33:230270. [PMID: 39048128 PMCID: PMC11267291 DOI: 10.1183/16000617.0270-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 05/15/2024] [Indexed: 07/27/2024] Open
Abstract
Diaphragmatic palsy after lung transplantation has been reported infrequently. Given the role of the diaphragm in respiration, the palsy may play a significant role in the post-surgical recovery as well as morbidity and mortality. This review summarises the current literature to better understand diaphragmatic palsy in the post lung-transplant setting among adults. A thorough literature search was conducted through multiple databases and 91 publications were identified that fit the research question. The review aimed to report the burden of this problem, explore different modalities of diagnosis reported, the effect of various clinical factors and treatment modalities, as well as their effects on outcomes. Additionally, it aimed to highlight the variability, limitations of reported data, and the absence of a standardised approach. This review emphasises the crucial need for more dedicated research to better address this clinical challenge.
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Affiliation(s)
- Amr M Eltonsy
- Cardiothoracic Surgery Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Karan Amlani
- Critical Care Department, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mary Schleicher
- Cleveland Clinic Floyd D. Loop Alumni Library, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Kenneth R McCurry
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Lionello F, Guarnieri G, Arcaro G, Bertagna De Marchi L, Molena B, Contessa C, Boscolo A, Rea F, Navalesi P, Vianello A. High-Flow Tracheal Oxygen for Tracheostomy Tube Removal in Lung Transplant Recipients. J Clin Med 2023; 12:7566. [PMID: 38137635 PMCID: PMC10743481 DOI: 10.3390/jcm12247566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Because of a complicated intraoperative course and/or poor recovery of graft function, approximately 15% of lung transplant (LT) recipients require prolonged mechanical ventilation (PMV) and receive a tracheostomy. This prospective study aimed to assess the effect of High-Flow Tracheal Oxygen (HFTO) on tracheostomy tube removal in LT recipients receiving PMV postoperatively. (2) Methods: The clinical course of 14 LT recipients receiving HFTO was prospectively evaluated and compared to that of 13 comparable controls receiving conventional oxygen therapy (COT) via tracheostomy. The study's primary endpoint was the number of patients whose tracheostomy tube was removed at discharge from an Intermediate Respiratory Care Unit (IRCU). (3) Results: Setting up HFTO proved easy, and it was well tolerated by all the patients. The number of patients whose tracheostomy tube was removed was significantly higher in the HFOT group compared to the COT group [13/14 vs. 6/13 (p = 0.0128)]. (4) Conclusions: HFTO is an effective, safe therapy that facilitates tracheostomy tube removal in LT recipients after weaning from PMV.
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Affiliation(s)
- Federico Lionello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Gabriella Guarnieri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Giovanna Arcaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Leonardo Bertagna De Marchi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Beatrice Molena
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Cristina Contessa
- Department of Directional Hospital Management, University of Padova, 35131 Padova, Italy;
| | - Annalisa Boscolo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
- Department of Medicine, University of Padova, 35131 Padova, Italy;
| | - Federico Rea
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
| | - Paolo Navalesi
- Department of Medicine, University of Padova, 35131 Padova, Italy;
| | - Andrea Vianello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35131 Padova, Italy; (F.L.); (G.G.); (G.A.); (L.B.D.M.); (B.M.); (A.B.); (F.R.)
- Fisiopatologia Respiratoria, Ospedale-Università di Padova, Via Giustiniani, 2, 35128 Padova, Italy
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