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Morosin M, Azzu A, Antonopoulos A, Kuhn T, Anandanadesan R, Garfield B, Aw TC, Ledot S, Bianchi P. Safety of tracheostomy during extracorporeal membrane oxygenation support: A single-center experience. Artif Organs 2023; 47:1762-1772. [PMID: 37610348 DOI: 10.1111/aor.14633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Some patients on extracorporeal membrane oxygenation (ECMO) require prolonged mechanical ventilation. An early tracheostomy strategy while on ECMO has appeared to be beneficial for these patients. This study aims to explore the safety of tracheostomy in ECMO patients. METHODS This is a retrospective observational single-center study. RESULTS Hundred and nine patients underwent tracheostomy (76 percutaneous and 33 surgical) during V-V ECMO support over an 8-year period. Patients with a percutaneous tracheostomy showed a significantly shorter ECMO duration [25.5 (17.3-40.1) vs 37.2 (26.5-53.2) days, p = 0.013] and a shorter ECMO-to-tracheostomy time [13.3 (8.5-19.7) vs 27.8 (16.3-36.9) days, p < 0.001] compared to those who underwent a surgical approach. There was no difference between the two strategies regarding both major and minor/no bleeding (p = 0.756). There was no difference in survival rate between patients who underwent percutaneous or surgical tracheostomy (p = 0.173). Patients who underwent an early tracheostomy (within 10 days from ECMO insertion) showed a significantly shorter hospital stay (p < 0.001) and a shorter duration of V-V ECMO support (p < 0.001). Our series includes 24 patients affected by COVID-19, who did not show significantly higher rates of major bleeding when compared to non-COVID-19 patients (p = 0.297). Within the COVID-19 subgroup, there was no difference in major bleeding rates between surgical and percutaneous approach (p = 1.0). CONCLUSIONS Percutaneous and surgical tracheostomy during ECMO have a similar safety profile in terms of bleeding risk and mortality. Percutaneous tracheostomy may favor a shorter duration of ECMO support and hospital stay and can be considered a safe alternative to surgical tracheostomy, even in COVID-19 patients, if relevant clinical expertise is available.
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Affiliation(s)
- Marco Morosin
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| | - Alessia Azzu
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| | - Alexios Antonopoulos
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| | - Timothy Kuhn
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| | - Rathai Anandanadesan
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| | - Benjamin Garfield
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Tuan-Chen Aw
- Department of Anaesthesia, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| | - Stephane Ledot
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Anaesthesia, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| | - Paolo Bianchi
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Anaesthesia, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
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Price LC, Garfield B, Bloom C, Jeyin N, Nissan D, Hull JH, Patel B, Jenkins G, Padley S, Man W, Singh S, Ridge CA. Persistent isolated impairment of gas transfer following COVID-19 pneumonitis relates to perfusion defects on dual energy Computed Tomography. ERJ Open Res 2022; 8:00224-2022. [PMID: 36447736 PMCID: PMC9548240 DOI: 10.1183/23120541.00224-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/04/2022] [Indexed: 12/04/2022] Open
Abstract
Breathlessness is common in patients after coronavirus disease 2019 (COVID-19) [1]. Patients may have an isolated impairment of gas transfer (diffusing capacity of the lung for carbon monoxide (DLCO)) at lung function testing, often without obvious interstitial lung disease or classical pulmonary emboli on imaging. Iodine maps from post-COVID-19 patients undergoing dual-energy computed tomography (DECT) demonstrate hypoenhancement in areas of normal lung parenchyma [2] (figure 1). We hypothesised that in breathless patients recovering from COVID-19, low DLCO would correlate with a computed tomography (CT) marker of lung perfusion, measured using DECT-derived iodine enhancement, including in patients where parenchymal disease was absent. As an even more specific indicator for the pulmonary vascular compartment, we hypothesised that the transfer coefficient of the lung for carbon monoxide (KCO) (i.e. DLCO corrected for alveolar volume) would even better correlate with DECT perfusion, and more so than forced vital capacity (FVC) and CT measures of interstitial lung involvement. A novel iodine perfusion score correlates with breathlessness and DLCO in patients post-#COVID19 without obvious interstitial disease on CT, suggesting that lung perfusion assessment may be useful in patients without another cause of dyspnoeahttps://bit.ly/3U6E2f5
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Garfield B, Handslip R, Patel BV. Ventilator-Associated Lung Injury. Encyclopedia of Respiratory Medicine 2022. [PMCID: PMC8128668 DOI: 10.1016/b978-0-08-102723-3.00237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Ventilatory support, while life saving, can also cause or aggravate lung injury through several mechanisms which are encompassed within ventilator-associated lung injury (VALI). The important realizationin the acute respiratory distress syndrome that the “baby” lung resided in non-dependent areas led to the conceptualization of “lung rest” to reduce stress and strain to exposed alveolar units. We discuss concepts and mechanisms within VALI that ultimately induce maladaptive lung responses, as well as, current and future management strategies to detect and mitigate VALI at the bedside.
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Garfield B, Bianchi P, Arachchillage D, Hartley P, Naruka V, Shroff D, Law A, Passariello M, Patel B, Price S, Rosenberg A, Singh S, Trimlett R, Xu T, Doyle J, Ledot S. Six Month Mortality in Patients with COVID-19 and Non-COVID-19 Viral Pneumonitis Managed with Veno-Venous Extracorporeal Membrane Oxygenation. ASAIO J 2021; 67:982-988. [PMID: 34144551 DOI: 10.1097/mat.0000000000001527] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
A significant proportion of patients with COVID-19 develop acute respiratory distress syndrome (ARDS) with high risk of death. The efficacy of veno-venous extracorporeal membrane oxygenation (VV-ECMO) for COVID-19 on longer-term outcomes, unlike in other viral pneumonias, is unknown. In this study, we aimed to compare the 6 month mortality of patients receiving VV-ECMO support for COVID-19 with a historical viral ARDS cohort. Fifty-three consecutive patients with COVID-19 ARDS admitted for VV-ECMO to the Royal Brompton Hospital between March 17, 2020 and May 30, 2020 were identified. Mortality, patient characteristics, complications, and ECMO parameters were then compared to a historical cohort of patients with non-COVID-19 viral pneumonia. At 6 months survival was significantly higher in the COVID-19 than in the non-COVID-19 viral pneumonia cohort (84.9% vs. 66.0%, p = 0.040). Patients with COVID-19 had an increased Murray score (3.50 vs. 3.25, p = 0.005), a decreased burden of organ dysfunction (sequential organ failure score score [8.76 vs. 10.42, p = 0.004]), an increased incidence of pulmonary embolism (69.8% vs. 24.5%, p < 0.001) and in those who survived to decannulation longer ECMO runs (19 vs. 11 days, p = 0.001). Our results suggest that survival in patients supported with EMCO for COVID-19 are at least as good as those treated for non-COVID-19 viral ARDS.
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Affiliation(s)
- Benjamin Garfield
- From the Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Paolo Bianchi
- From the Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Anaesthesia, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Deepa Arachchillage
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, United Kingdom
- Department of Haematology, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Philip Hartley
- Imperial College Healthcare NHS Foundation Trust, London, United Kingdom
| | - Vinci Naruka
- Imperial College Healthcare NHS Foundation Trust, London, United Kingdom
| | - Diana Shroff
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Alexander Law
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Maurizio Passariello
- From the Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Brijesh Patel
- From the Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Susanna Price
- From the Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Alexander Rosenberg
- From the Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Suveer Singh
- From the Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Richard Trimlett
- Department of Cardiac Surgery, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Tina Xu
- From the Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - James Doyle
- From the Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Stephane Ledot
- From the Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Department of Anaesthesia, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
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Weatherill A, Laffan M, Gasper M, Bianchi P, Passariello M, Singh S, Doyle J, Patel B, Ledot S, Garfield B, Arachchillage DJ. Impact of Thrombosis and Bleeding in Patients with Severe COVID-19 versus Other Viral Pneumonias in the Context of Extracorporeal Membrane Oxygenation. Semin Thromb Hemost 2021; 48:118-123. [PMID: 34388841 DOI: 10.1055/s-0041-1732371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Anna Weatherill
- Department of Haematology, Imperial College Healthcare NHS Trust Imperial College London, London, United Kingdom
| | - Mike Laffan
- Department of Haematology, Imperial College Healthcare NHS Trust Imperial College London, London, United Kingdom.,Centre for Haematology, Imperial College London, London, United Kingdom
| | - Mihaela Gasper
- Department of Haematology, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Paolo Bianchi
- Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom.,Division of Anesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Anesthesia, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Maurizio Passariello
- Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Suveer Singh
- Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom.,Division of Anesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - James Doyle
- Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Brijesh Patel
- Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom.,Division of Anesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Stephane Ledot
- Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom.,Division of Anesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Anesthesia, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
| | - Benjamin Garfield
- Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom.,Division of Anesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Deepa J Arachchillage
- Department of Haematology, Imperial College Healthcare NHS Trust Imperial College London, London, United Kingdom.,Centre for Haematology, Imperial College London, London, United Kingdom.,Department of Haematology, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom
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6
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Price LC, Martinez G, Brame A, Pickworth T, Samaranayake C, Alexander D, Garfield B, Aw TC, McCabe C, Mukherjee B, Harries C, Kempny A, Gatzoulis M, Marino P, Kiely DG, Condliffe R, Howard L, Davies R, Coghlan G, Schreiber BE, Lordan J, Taboada D, Gaine S, Johnson M, Church C, Kemp SV, Wong D, Curry A, Levett D, Price S, Ledot S, Reed A, Dimopoulos K, Wort SJ. Perioperative management of patients with pulmonary hypertension undergoing non-cardiothoracic, non-obstetric surgery: a systematic review and expert consensus statement. Br J Anaesth 2021; 126:774-790. [PMID: 33612249 DOI: 10.1016/j.bja.2021.01.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The risk of complications, including death, is substantially increased in patients with pulmonary hypertension (PH) undergoing anaesthesia for surgical procedures, especially in those with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH). Sedation also poses a risk to patients with PH. Physiological changes including tachycardia, hypotension, fluid shifts, and an increase in pulmonary vascular resistance (PH crisis) can precipitate acute right ventricular decompensation and death. METHODS A systematic literature review was performed of studies in patients with PH undergoing non-cardiac and non-obstetric surgery. The management of patients with PH requiring sedation for endoscopy was also reviewed. Using a framework of relevant clinical questions, we review the available evidence guiding operative risk, risk assessment, preoperative optimisation, and perioperative management, and identifying areas for future research. RESULTS Reported 30 day mortality after non-cardiac and non-obstetric surgery ranges between 2% and 18% in patients with PH undergoing elective procedures, and increases to 15-50% for emergency surgery, with complications and death usually relating to acute right ventricular failure. Risk factors for mortality include procedure-specific and patient-related factors, especially markers of PH severity (e.g. pulmonary haemodynamics, poor exercise performance, and right ventricular dysfunction). Most studies highlight the importance of individualised preoperative risk assessment and optimisation and advanced perioperative planning. CONCLUSIONS With an increasing number of patients requiring surgery in specialist and non-specialist PH centres, a systematic, evidence-based, multidisciplinary approach is required to minimise complications. Adequate risk stratification and a tailored-individualised perioperative plan is paramount.
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Affiliation(s)
- Laura C Price
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK.
| | - Guillermo Martinez
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
| | - Aimee Brame
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | | | | | - David Alexander
- Department of Anaesthesia, Royal Brompton Hospital, London, UK
| | - Benjamin Garfield
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Tuan-Chen Aw
- Department of Anaesthesia, Royal Brompton Hospital, London, UK
| | - Colm McCabe
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Bhashkar Mukherjee
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | - Carl Harries
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | - Aleksander Kempny
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael Gatzoulis
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Philip Marino
- Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | - David G Kiely
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Robin Condliffe
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Luke Howard
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Rachel Davies
- National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Gerry Coghlan
- National Pulmonary Hypertension Service, Royal Free Hospital, London, UK
| | | | - James Lordan
- National Pulmonary Hypertension Service, Freeman Hospital, Newcastle upon Tyne, UK
| | - Dolores Taboada
- Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK
| | - Sean Gaine
- National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Martin Johnson
- Scottish Pulmonary Vascular Unit, NHS Golden Jubilee, Clydebank, UK
| | - Colin Church
- Scottish Pulmonary Vascular Unit, NHS Golden Jubilee, Clydebank, UK
| | - Samuel V Kemp
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Davina Wong
- Intensive Care unit and Pulmonary Hypertension Service, London, UK
| | - Andrew Curry
- Cardiothoracic Anaesthesia, University Hospital Southampton, Southampton, Hampshire, UK
| | - Denny Levett
- Anaesthesia and Critical Care Research Area, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Stephane Ledot
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Anna Reed
- National Heart and Lung Institute, Imperial College London, London, UK; Respiratory and Lung Transplantation, Harefield Hospital, Uxbridge, UK
| | - Konstantinos Dimopoulos
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Stephen John Wort
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
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Garfield B, McFadyen C, Briar C, Bleakley C, Vlachou A, Baldwin M, Lees N, Price S, Ledot S, McCabe C, Wort SJ, Patel BV, Price LC. Potential for personalised application of inhaled nitric oxide in COVID-19 pneumonia. Br J Anaesth 2021; 126:e72-e75. [PMID: 33288208 PMCID: PMC7666572 DOI: 10.1016/j.bja.2020.11.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Benjamin Garfield
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Charlotte Briar
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | | | | | - Melissa Baldwin
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Nick Lees
- Adult Intensive Care Unit, Harefield Hospital, Harefield, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Stephane Ledot
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - Colm McCabe
- National Heart and Lung Institute, Imperial College London, London, UK; National Pulmonary Hypertension Service, Royal Brompton Hospital, UK
| | - S John Wort
- National Heart and Lung Institute, Imperial College London, London, UK; National Pulmonary Hypertension Service, Royal Brompton Hospital, UK
| | - Brijesh V Patel
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK; Anaesthetics, Pain Medicine and Intensive Care, Surgery and Cancer, Imperial College London, UK
| | - Laura C Price
- National Heart and Lung Institute, Imperial College London, London, UK; National Pulmonary Hypertension Service, Royal Brompton Hospital, UK.
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Garfield B, Abdoolraheem MY, Dixon A, Aswani A, Paul R, Sherren P, Glover G. Temporal Changes in Targeted Temperature Management for Out-of-Hospital Cardiac Arrest-Examining the Effect of the Targeted Temperature Management Trial: A Retrospective Cohort Study. Ther Hypothermia Temp Manag 2020; 11:230-237. [PMID: 33332235 DOI: 10.1089/ther.2020.0028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Targeted temperature management (TTM) is recommended after out-of-hospital cardiac arrest (OHCA). However, interpretation of the evidence and translation into clinical practice, to realize benefits to patient outcomes may be inconsistent. This study aims to compare compliance with the recommended targeted temperatures and the use of intravascular temperature management (IVTM), as well as 90-day survival, before and after publication of the TTM trial. A single-center retrospective cohort study was conducted from 2010 to 2017. All comatose patients admitted to the intensive care unit after OHCA, who survived for ≥24 hours, were included. IVTM use was measured and TTM adherence was defined as the percentage time the core temperature was (1) within the guideline-recommended temperature range (initially 32-34°C, later modified to 32-36°C) for the first 24 hours, and (2) ≤37.5°C between 24 and 72 hours following admission. Multiple logistic regression analyses were performed for the use of IVTM and survival at 90 days. Of the 302 patients identified, 136 (45%) were pre-TTM, and 166 (55%) post-TTM. Baseline characteristics were similar between the groups. IVTM use decreased significantly (77.9% vs. 51.8%, p < 0.001) after the publication of the TTM trial. Adherence to the 32-34°C and 32-36°C targets was higher pre-TTM as compared with the post-TTM cohort (33.3% [0-66.7%] vs. 0% [0-16.7%], p < 0.001 and 83.3% [50.0-100%] vs. 36.7% [16.7-66.7%], p < 0.001, respectively). Time with temperature ≥37.5°C in the first 24 hours was higher post-TTM (p = < 0.001) but not between 24 and 72 hours. Ninety-day survival was 54.4% in the pre-TTM cohort and 44.0% post-TTM, (odds ratio 1.52 [0.96-2.40], p = 0.083). Adherence with recommended TTM decreased significantly following publication of the TTM trial and this was explained by a significant decrease in IVTM use. However, this concerning trend did not result in a statistically significant difference in survival.
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Affiliation(s)
- Benjamin Garfield
- Department of Critical Care, Guy's and St. Thomas', King's College London, London, United Kingdom
| | | | - Alison Dixon
- Department of Critical Care, Guy's and St. Thomas', King's College London, London, United Kingdom
| | - Andrew Aswani
- Department of Critical Care, Guy's and St. Thomas', King's College London, London, United Kingdom
| | - Richard Paul
- Department of Critical Care, Guy's and St. Thomas', King's College London, London, United Kingdom
| | - Peter Sherren
- Department of Critical Care, Guy's and St. Thomas', King's College London, London, United Kingdom
| | - Guy Glover
- Department of Critical Care, Guy's and St. Thomas', King's College London, London, United Kingdom
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9
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Bleakley C, Singh S, Garfield B, Morosin M, Surkova E, Mandalia MS, Dias B, Androulakis E, Price LC, McCabe C, Wort SJ, West C, Li W, Khattar R, Senior R, Patel BV, Price S. Right ventricular dysfunction in critically ill COVID-19 ARDS. Int J Cardiol 2020; 327:251-258. [PMID: 33242508 PMCID: PMC7681038 DOI: 10.1016/j.ijcard.2020.11.043] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023]
Abstract
Aims Comprehensive echocardiography assessment of right ventricular (RV) impairment has not been reported in critically ill patients with COVID-19. We detail the specific phenotype and clinical associations of RV impairment in COVID-19 acute respiratory distress syndrome (ARDS). Methods Transthoracic echocardiography (TTE) measures of RV function were collected in critically unwell patients for associations with clinical, ventilatory and laboratory data. Results Ninety patients (25.6% female), mean age 52.0 ± 10.8 years, veno-venous extracorporeal membrane oxygenation (VVECMO) (42.2%) were studied. A significantly higher proportion of patients were identified as having RV dysfunction by RV fractional area change (FAC) (72.0%,95% confidence interval (CI) 61.0–81.0) and RV velocity time integral (VTI) (86.4%, 95 CI 77.3–93.2) than by tricuspid annular plane systolic excursion (TAPSE) (23.8%, 95 CI 16.0–33.9), RVS’ (11.9%, 95% CI 6.6–20.5) or RV free wall strain (FWS) (35.3%, 95% CI 23.6–49.0). RV VTI correlated strongly with RV FAC (p ≤ 0.01). Multivariate regression demonstrated independent associations of RV FAC with NTpro-BNP and PVR. RV-PA coupling correlated with PVR (univariate p < 0.01), as well as RVEDAi (p < 0.01), and RVESAi (p < 0.01), and was associated with P/F ratio (p 0.026), PEEP (p 0.025), and ALT (p 0.028). Conclusions Severe COVID-19 ARDS is associated with a specific phenotype of RV radial impairment with sparing of longitudinal function. Clinicians should avoid interpretation of RV health purely on long-axis parameters in these patients. RV-PA coupling potentially provides important additional information above standard measures of RV performance in this cohort.
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Affiliation(s)
- Caroline Bleakley
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, UK; Department of Adult Critical Care, Royal Brompton Hospital, Sydney Street, London, UK
| | - Suveer Singh
- Department of Adult Critical Care, Royal Brompton Hospital, Sydney Street, London, UK
| | - Benjamin Garfield
- Department of Adult Critical Care, Royal Brompton Hospital, Sydney Street, London, UK
| | - Marco Morosin
- Department of Adult Critical Care, Royal Brompton Hospital, Sydney Street, London, UK
| | - Elena Surkova
- Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London, UK
| | | | - Bernardo Dias
- Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London, UK
| | | | - Laura C Price
- Pulmonary Hypertension Service, Royal Brompton Hospital, Sydney Street, London, UK
| | - Colm McCabe
- Pulmonary Hypertension Service, Royal Brompton Hospital, Sydney Street, London, UK
| | - Stephen John Wort
- Pulmonary Hypertension Service, Royal Brompton Hospital, Sydney Street, London, UK
| | - Cathy West
- Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London, UK
| | - Wei Li
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, UK; Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London, UK
| | - Rajdeep Khattar
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, UK; Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London, UK
| | - Roxy Senior
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, UK; Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London, UK
| | - Brijesh V Patel
- Department of Adult Critical Care, Royal Brompton Hospital, Sydney Street, London, UK
| | - Susanna Price
- Department of Cardiology, Royal Brompton Hospital, Sydney Street, London, UK; Department of Adult Critical Care, Royal Brompton Hospital, Sydney Street, London, UK.
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Price LC, Garfield B, Bleakley C, Keeling AG, Mcfadyen C, McCabe C, Ridge CA, Wort SJ, Price S, Arachchillage DJ. Rescue therapy with thrombolysis in patients with severe COVID-19-associated acute respiratory distress syndrome. Pulm Circ 2020; 10:2045894020973906. [PMID: 33403100 PMCID: PMC7745572 DOI: 10.1177/2045894020973906] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/24/2020] [Indexed: 12/14/2022] Open
Abstract
Acute respiratory distress syndrome in patients with Coronavirus disease 19 is associated with an unusually high incidence of pulmonary embolism and microthrombotic disease, with evidence for reduced fibrinolysis. We describe seven patients requiring invasive ventilation for COVID-19-associated acute respiratory distress syndrome with pulmonary thromboembolic disease, pulmonary hypertension ± severe right ventricular dysfunction on echocardiography, who were treated with alteplase as fibrinolytic therapy. All patients were non-smokers, six (86%) were male and median age was 56.7 (50-64) years. They had failed approaches including therapeutic anticoagulation, prone ventilation (n = 4), inhaled nitric oxide (n = 5) and nebulised epoprostenol (n = 2). The median duration of mechanical ventilation prior to thrombolysis was seven (5-11) days. Systemic alteplase was administered to six patients (50 mg or 90 mg bolus over 120 min) at 16 (10-22) days after symptom onset. All received therapeutic heparin pre- and post-thrombolysis, without intracranial haemorrhage or other major bleeding. Alteplase improved PaO2/FiO2 ratio (from 97.0 (86.3-118.6) to 135.6 (100.7-171.4), p = 0.03) and ventilatory ratio (from 2.76 (2.09-3.49) to 2.36 (1.82-3.05), p = 0.011) at 24 h. Echocardiographic parameters at two (1-3) days (n = 6) showed right ventricular systolic pressure (RVSP) was 63 (50.3-75) then 57 (49-66) mmHg post-thrombolysis (p = 0.26), tricuspid annular planar systolic excursion (TAPSE) was unchanged (from 18.3 (11.9-24.5) to 20.5 (15.4-24.2) mm, p = 0.56) and right ventricular fractional area change (from 15.4 (11.1-35.6) to 31.2 (16.4-33.1)%, p = 0.09). At seven (1-13) days after thrombolysis, using dual energy computed tomography imaging (n = 3), average relative peripheral lung enhancement increased from 12.6 to 21.6% (p = 0.06). In conclusion, thrombolysis improved PaO2/FiO2 ratio and ventilatory ratio at 24 h as rescue therapy in patients with right ventricular dysfunction due to COVID-19-associated ARDS despite maximum therapy, as part of a multimodal approach, and warrants further study.
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Affiliation(s)
- Laura C. Price
- National Pulmonary Hypertension Service, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Benjamin Garfield
- National Pulmonary Hypertension Service, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Intensive Care Medicine, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Caroline Bleakley
- Department of Intensive Care Medicine, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | | | - Charles Mcfadyen
- Department of Intensive Care Medicine, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Colm McCabe
- National Pulmonary Hypertension Service, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Carole A. Ridge
- Department of Radiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Stephen J. Wort
- National Pulmonary Hypertension Service, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Susanna Price
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Intensive Care Medicine, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Deepa J. Arachchillage
- Department of Haematology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Department of Immunology and Inflammation, Imperial College London, London, UK
- Department of Haematology, Imperial College Healthcare NHS Trust, London, UK
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11
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Patel BV, Arachchillage DJ, Ridge CA, Bianchi P, Doyle JF, Garfield B, Ledot S, Morgan C, Passariello M, Price S, Singh S, Thakuria L, Trenfield S, Trimlett R, Weaver C, Wort SJ, Xu T, Padley SPG, Devaraj A. Pulmonary Angiopathy in Severe COVID-19: Physiologic, Imaging, and Hematologic Observations. Am J Respir Crit Care Med 2020; 202:690-699. [PMID: 32667207 PMCID: PMC7462405 DOI: 10.1164/rccm.202004-1412oc] [Citation(s) in RCA: 208] [Impact Index Per Article: 52.0] [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] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023] Open
Abstract
Rationale: Clinical and epidemiologic data in coronavirus disease (COVID-19) have accrued rapidly since the outbreak, but few address the underlying pathophysiology.Objectives: To ascertain the physiologic, hematologic, and imaging basis of lung injury in severe COVID-19 pneumonia.Methods: Clinical, physiologic, and laboratory data were collated. Radiologic (computed tomography (CT) pulmonary angiography [n = 39] and dual-energy CT [DECT, n = 20]) studies were evaluated: observers quantified CT patterns (including the extent of abnormal lung and the presence and extent of dilated peripheral vessels) and perfusion defects on DECT. Coagulation status was assessed using thromboelastography.Measurements and Results: In 39 consecutive patients (male:female, 32:7; mean age, 53 ± 10 yr [range, 29-79 yr]; Black and minority ethnic, n = 25 [64%]), there was a significant vascular perfusion abnormality and increased physiologic dead space (dynamic compliance, 33.7 ± 14.7 ml/cm H2O; Murray lung injury score, 3.14 ± 0.53; mean ventilatory ratios, 2.6 ± 0.8) with evidence of hypercoagulability and fibrinolytic "shutdown". The mean CT extent (±SD) of normally aerated lung, ground-glass opacification, and dense parenchymal opacification were 23.5 ± 16.7%, 36.3 ± 24.7%, and 42.7 ± 27.1%, respectively. Dilated peripheral vessels were present in 21/33 (63.6%) patients with at least two assessable lobes (including 10/21 [47.6%] with no evidence of acute pulmonary emboli). Perfusion defects on DECT (assessable in 18/20 [90%]) were present in all patients (wedge-shaped, n = 3; mottled, n = 9; mixed pattern, n = 6).Conclusions: Physiologic, hematologic, and imaging data show not only the presence of a hypercoagulable phenotype in severe COVID-19 pneumonia but also markedly impaired pulmonary perfusion likely caused by pulmonary angiopathy and thrombosis.
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Affiliation(s)
- Brijesh V. Patel
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer
- Centre for Haematology, Department of Immunology and Inflammation, and
| | - Deepa J. Arachchillage
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Adult Intensive Care
| | | | | | | | | | | | | | | | - Susanna Price
- Department of Haematology
- Department of Adult Intensive Care, and
| | - Suveer Singh
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer
- Department of Adult Intensive Care, and
| | | | | | | | | | - S. John Wort
- Department of Haematology
- The Pulmonary Hypertension Service, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Tina Xu
- Department of Adult Intensive Care, and
| | | | | | - the Severe Acute Respiratory Failure Service and The Departments of Anaesthesia and Critical Care, Royal Brompton Hospital
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer
- Centre for Haematology, Department of Immunology and Inflammation, and
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Department of Adult Intensive Care
- Department of Haematology
- Department of Radiology
- Department of Adult Intensive Care, and
- The Pulmonary Hypertension Service, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
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12
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Bleakley C, Smith R, Garfield B, Jackson T, Remmington C, Patel BV, Price S. Contrast Echocardiography in VV-ECMO-Dependent Patients with COVID-19. J Am Soc Echocardiogr 2020; 33:1419-1420. [PMID: 32888757 PMCID: PMC7366993 DOI: 10.1016/j.echo.2020.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Caroline Bleakley
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Adult Critical Care, Royal Brompton Hospital, London, United Kingdom
| | - Rosie Smith
- Department of Adult Critical Care, Royal Brompton Hospital, London, United Kingdom; Perfusion, Royal Brompton Hospital, London, United Kingdom
| | - Benjamin Garfield
- Department of Adult Critical Care, Royal Brompton Hospital, London, United Kingdom
| | - Timothy Jackson
- Department of Adult Critical Care, Royal Brompton Hospital, London, United Kingdom; Perfusion, Royal Brompton Hospital, London, United Kingdom
| | - Chris Remmington
- Department of Adult Critical Care, Royal Brompton Hospital, London, United Kingdom; Department of Clinical Pharmacy, Royal Brompton Hospital, London, United Kingdom
| | - Brijesh V Patel
- Department of Adult Critical Care, Royal Brompton Hospital, London, United Kingdom
| | - Susanna Price
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Department of Adult Critical Care, Royal Brompton Hospital, London, United Kingdom
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13
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Ramakrishnan L, Pedersen SL, Toe QK, West LE, Mumby S, Casbolt H, Issitt T, Garfield B, Lawrie A, Wort SJ, Quinlan GJ. The Hepcidin/Ferroportin axis modulates proliferation of pulmonary artery smooth muscle cells. Sci Rep 2018; 8:12972. [PMID: 30154413 PMCID: PMC6113242 DOI: 10.1038/s41598-018-31095-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/10/2018] [Indexed: 12/22/2022] Open
Abstract
Studies were undertaken to examine any role for the hepcidin/ferroportin axis in proliferative responses of human pulmonary artery smooth muscle cells (hPASMCs). Entirely novel findings have demonstrated the presence of ferroportin in hPASMCs. Hepcidin treatment caused increased proliferation of these cells most likely by binding ferroportin resulting in internalisation and cellular iron retention. Cellular iron content increased with hepcidin treatment. Stabilisation of ferroportin expression and activity via intervention with the therapeutic monoclonal antibody LY2928057 reversed proliferation and cellular iron accumulation. Additionally, IL-6 treatment was found to enhance proliferation and iron accumulation in hPASMCs; intervention with LY2928057 prevented this response. IL-6 was also found to increase hepcidin transcription and release from hPASMCs suggesting a potential autocrine response. Hepcidin or IL-6 mediated iron accumulation contributes to proliferation in hPASMCs; ferroportin mediated cellular iron excretion limits proliferation. Haemoglobin also caused proliferation of hPASMCs; in other novel findings, CD163, the haemoglobin/haptoglobin receptor, was found on these cells and offers a means for cellular uptake of iron via haemoglobin. Il-6 was also found to modulate CD163 on these cells. These data contribute to a better understanding of how disrupted iron homeostasis may induce vascular remodelling, such as in pulmonary arterial hypertension.
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MESH Headings
- Antibodies, Monoclonal/pharmacology
- Antigens, CD/metabolism
- Antigens, Differentiation, Myelomonocytic/metabolism
- Autocrine Communication/drug effects
- Autocrine Communication/physiology
- Cation Transport Proteins/biosynthesis
- Cell Proliferation
- Cells, Cultured
- Gene Expression Regulation/drug effects
- Gene Expression Regulation/physiology
- Hepcidins/biosynthesis
- Humans
- Interleukin-6/metabolism
- Iron/metabolism
- Muscle, Smooth, Vascular/cytology
- Muscle, Smooth, Vascular/metabolism
- Myocytes, Smooth Muscle/cytology
- Myocytes, Smooth Muscle/metabolism
- Pulmonary Artery/cytology
- Pulmonary Artery/metabolism
- Receptors, Cell Surface/metabolism
- Transcription, Genetic/drug effects
- Transcription, Genetic/physiology
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Affiliation(s)
- Latha Ramakrishnan
- Vascular Biology Group, National Heart and Lung Institute, Imperial College London, Faculty of Medicine, Guy Scadding Building, London, SW3 6LY, UK
| | - Sofia L Pedersen
- Vascular Biology Group, National Heart and Lung Institute, Imperial College London, Faculty of Medicine, Guy Scadding Building, London, SW3 6LY, UK
| | - Quezia K Toe
- Vascular Biology Group, National Heart and Lung Institute, Imperial College London, Faculty of Medicine, Guy Scadding Building, London, SW3 6LY, UK
| | - Laura E West
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, S10 2RX, Sheffield, UK
| | - Sharon Mumby
- Vascular Biology Group, National Heart and Lung Institute, Imperial College London, Faculty of Medicine, Guy Scadding Building, London, SW3 6LY, UK
| | - Helen Casbolt
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, S10 2RX, Sheffield, UK
| | - Theo Issitt
- Vascular Biology Group, National Heart and Lung Institute, Imperial College London, Faculty of Medicine, Guy Scadding Building, London, SW3 6LY, UK
| | - Benjamin Garfield
- Vascular Biology Group, National Heart and Lung Institute, Imperial College London, Faculty of Medicine, Guy Scadding Building, London, SW3 6LY, UK
| | - Allan Lawrie
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, S10 2RX, Sheffield, UK
| | - S John Wort
- Vascular Biology Group, National Heart and Lung Institute, Imperial College London, Faculty of Medicine, Guy Scadding Building, London, SW3 6LY, UK
| | - Gregory J Quinlan
- Vascular Biology Group, National Heart and Lung Institute, Imperial College London, Faculty of Medicine, Guy Scadding Building, London, SW3 6LY, UK.
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14
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Garfield B, Shao D, Crosby A, Yang P, Morrell N, Polkey M, Kemp P, Wort SJ. P268 The role of growth and differentiation factor 15 in smooth muscle cell proliferation in pulmonary hypertension. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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15
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Garfield B, Parfitt L, Harries C, Dimopoulos K, Gatzoulis M, Kemp P, Polkey M, Wort S. S144 Quality Of Life In Idiopathic Pulmonary Arterial Hypertension Is Associated With Quadriceps Function And Size. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Keir GJ, Garfield B, Hansell DM, Loebinger MR, Wilson R, Renzoni EA, Wells AU, Maher TM. Cyclical caspofungin for chronic pulmonary aspergillosis in sarcoidosis. Thorax 2013; 69:287-8. [DOI: 10.1136/thoraxjnl-2013-203988] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Asimacopoulos EP, Berry M, Garfield B, Roesner M, Jepson A, McCarthy J, Kon OM. The diagnostic efficacy of fine-needle aspiration using cytology and culture in tuberculous lymphadenitis. Int J Tuberc Lung Dis 2010; 14:93-98. [PMID: 20003701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To retrospectively assess the diagnostic efficacy of fine-needle aspiration (FNA) using cytological and microbiological examinations in tuberculous lymphadenitis. METHODS Patients with tuberculous lymphadenitis treated at St Mary's Hospital, London, between January 2001 and June 2007 were identified. The cytological and microbiological reports of 97 patients were found. The criteria for a definite diagnosis of tuberculous lymphadenitis were based on a compatible clinical history, tuberculin positivity and either an indicative cytological result or positive culture. RESULTS In 77 of the 97 (79%) cases, FNA cytology showed evidence of a tuberculous process. In 65 cases, Mycobacterium tuberculosis was cultured from the aspirates, and 54 of these 65 cases showed corresponding cytological evidence of a tuberculous process; 23 cases were diagnosed by cytology but not microbiology, while 11 cases were diagnosed by microbiology but not cytology. CONCLUSION Cytological and microbiological results appeared to correlate well, but each also gives an exclusive diagnosis. When combining both modalities, the diagnostic efficacy of FNA rises to 91%. A definitive microbiological diagnosis was achieved in 67% of cases and provided information on drug susceptibility. We conclude that samples should be provided for both cytological and microbiological examination when using FNA to diagnose possible tuberculous lymphadenitis.
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Affiliation(s)
- E P Asimacopoulos
- Chest and Allergy Clinic, St Mary's Hospital, Imperial College Healthcare National Health Services Trust, London, UK
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18
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Wang M, Dunn WR, Chan SL, Garfield B, Wilson VG. Evidence for Nonadrenoceptor Responses to Imidazoline Derivatives in the Porcine Isolated Rectal Artery. Ann N Y Acad Sci 2003; 1009:386-91. [PMID: 15028617 DOI: 10.1196/annals.1304.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
High concentrations of phentolamine, efaroxan, and idazoxan were found to produce nonadrenoceptor contractions of the porcine isolated rectal artery previously exposed to U46619 and forskolin. These responses were insensitive to the putative imidazoline I(3) receptor antagonist KU-14R, unlike those previously reported in this preparation for oxymetazoline. The pharmacologic nature of this response and the obligate requirement for preconstriction suggests that these imidazoline derivatives modulate ion channel function through a novel nonadrenergic site.
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Affiliation(s)
- Minyan Wang
- School of Biomedical Sciences, University of Nottingham, Nottingham, UK
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