- Twenty-year follow-up of the first bilateral living-donor lobar lung transplantation in Japan. [Journal Article]
- IMIntern Med 2019 Jul 10
- Patients with end-stage lung disease can undergo living-donor lobar lung transplantation (LDLLT), with survival rates improving every year. We herein report the 20-year follow-up findings of the firs…
Patients with end-stage lung disease can undergo living-donor lobar lung transplantation (LDLLT), with survival rates improving every year. We herein report the 20-year follow-up findings of the first patient who underwent LDLLT in Japan. A 24-year-old woman with primary ciliary dyskinesia became ventilator-dependent after severe respiratory failure and right-sided heart failure following repeated respiratory infections. In 1998, she underwent LDLLT and received her sister's right lower lobe and her mother's left lower lobe. Although the patient required 21 hospitalizations and developed unilateral bronchiolitis obliterans syndrome, she is in good physical condition and lives without restriction at 20 years after undergoing LDLLT.
- Predictors of Early Extubation after Patent Ductus Arteriosus Ligation among Infants Born Extremely Preterm Dependent on Mechanical Ventilation. [Journal Article]
- JPedJ Pediatr 2019 Jul 03
- We conducted a retrospective study of 166 ventilator-dependent neonates born extremely preterm in whom patent ductus arteriosus was surgically ligated and evaluated the association of preoperative ch…
We conducted a retrospective study of 166 ventilator-dependent neonates born extremely preterm in whom patent ductus arteriosus was surgically ligated and evaluated the association of preoperative characteristics and time-to-successful postoperative extubation. Larger patent ductus arteriosus diameter ([>2.5 mm], adjusted hazard ratio 0.51, 95% CI 0.36-0.72) and left-ventricular dilatation (z score ≥2, adjusted hazard ratio 0.61, 95% CI 0.42-0.87) were associated with earlier extubation.
- Differences in Clinical Characteristics and Therapy of Neonatal Acute Respiratory Distress Syndrome (ARDS) and Respiratory Distress Syndrome (RDS): A Retrospective Analysis of 925 Cases. [Journal Article]
- MSMed Sci Monit 2019 Jul 06; 25:4992-4998
- CONCLUSIONS: ARDS mainly occurs in late preterm infants. Its treatment is dependent on iNO and invasive ventilator-assisted therapy, and the surfactant treatment rate was relatively lower in comparison to RDS. RDS accompanied with inflammatory response is also dependent on prolonged use of an invasive ventilator.
- Short-Term Effects of an Active Heat-and-Moisture Exchanger During Invasive Ventilation. [Journal Article]
- RCRespir Care 2019 Jul 03
- CONCLUSIONS: This study indicated that, compared with the heated humidifiers, the use of the active HME or the HME increased inspiratory effort, P aCO2 , pH, and dyspnea in stable subjects who were tracheostomized and ventilator-dependent.
- Using flexible methods to determine risk factors for ventilator-associated pneumonia in the Netherlands. [Journal Article]
- PlosPLoS One 2019; 14(6):e0218372
- Seven hospitals participated in the Dutch national surveillance for ventilator-associated pneumonia (VAP) and its risk factors. We analysed time-independent and time-dependent risk factors for VAP us…
Seven hospitals participated in the Dutch national surveillance for ventilator-associated pneumonia (VAP) and its risk factors. We analysed time-independent and time-dependent risk factors for VAP using the standard Cox regression and the flexible Weighted Cumulative Effects method (WCE) that evaluates both current and past exposures. The prospective surveillance of intensive care patients aged ≥16 years and ventilated ≥48 hours resulted in the inclusion of 940 primary ventilation periods, comprising 7872 ventilation days. The average VAP incidence density was 10.3/1000 ventilation days. Independent risk factors were age (16-40 years at increased risk: HR 2.42 95% confidence interval 1.07-5.50), COPD (HR 0.19 [0.04-0.78]), current sedation score (higher scores at increased risk), current selective oropharyngeal decontamination (HR 0.19 [0.04-0.91]), jet nebulizer (WCE, decreased risk), intravenous antibiotics for selective decontamination of the digestive tract (ivSDD, WCE, decreased risk), and intravenous antibiotics not for SDD (WCE, decreased risk). The protective effect of ivSDD was afforded for 24 days with a delay of 3 days. For some time-dependent variables, the WCE model was preferable over standard Cox proportional hazard regression. The WCE method can furthermore increase insight into the active time frame and possible delay herein of a time-dependent risk factor.
- The population-attributable fraction for time-dependent exposures using dynamic prediction and landmarking. [Journal Article]
- BJBiom J 2019 Jun 19
- The public health impact of a harmful exposure can be quantified by the population-attributable fraction (PAF). The PAF describes the attributable risk due to an exposure and is often interpreted as …
The public health impact of a harmful exposure can be quantified by the population-attributable fraction (PAF). The PAF describes the attributable risk due to an exposure and is often interpreted as the proportion of preventable cases if the exposure was extinct. Difficulties in the definition and interpretation of the PAF arise when the exposure of interest depends on time. Then, the definition of exposed and unexposed individuals is not straightforward. We propose dynamic prediction and landmarking to define and estimate a PAF in this data situation. Two estimands are discussed which are based on two hypothetical interventions that could prevent the exposure in different ways. Considering the first estimand, at each landmark the estimation problem is reduced to a time-independent setting. Then, estimation is simply performed by using a generalized-linear model accounting for the current exposure state and further (time-varying) covariates. The second estimand is based on counterfactual outcomes, estimation can be performed using pseudo-values or inverse-probability weights. The approach is explored in a simulation study and applied on two data examples. First, we study a large French database of intensive care unit patients to estimate the population-benefit of a pathogen-specific intervention that could prevent ventilator-associated pneumonia caused by the pathogen Pseudomonas aeruginosa. Moreover, we quantify the population-attributable burden of locoregional and distant recurrence in breast cancer patients.
- Ambroxol alleviates ventilator-induced lung injury by inhibiting c-Jun expression. [Journal Article]
- EREur Rev Med Pharmacol Sci 2019; 23(11):5004-5011
- CONCLUSIONS: Ambroxol increases γ-GCS to promote GSH production, which in turn, inhibits ROS-dependent AP-1 activation and inflammation.
- Early clinical experience of bacteriophage therapy in 3 lung transplant recipients. [Journal Article]
- AJAm J Transplant 2019 Jun 17
- Bacteriophage therapy (BT) uses bacteriophages to treat pathogenic bacteria and is an emerging strategy against multidrug-resistant (MDR) infections. Experience in solid organ transplant is limited. …
Bacteriophage therapy (BT) uses bacteriophages to treat pathogenic bacteria and is an emerging strategy against multidrug-resistant (MDR) infections. Experience in solid organ transplant is limited. We describe BT in 3 lung transplant recipients (LTR) with life-threatening MDR infections caused by Pseudomonas aeruginosa (n = 2) and Burkholderia dolosa (n = 1). For each patient, lytic bacteriophages were selected against their bacterial isolates. BT was administered for variable durations under emergency Investigational New Drug applications and with patient informed consent. Safety was assessed using clinical/laboratory parameters and observed clinical improvements described, as appropriate. All patients received concurrent antibiotics. Two ventilator-dependent LTR with large airway complications and refractory MDR P. aeruginosa pneumonia received BT. Both responded clinically and were discharged from the hospital off ventilator support. A third patient had recurrent B. dolosa infection following transplant. Following BT initiation, consolidative opacities improved and ventilator weaning was begun. However, infection relapsed on BT and the patient died. No BT-related adverse events were identified in the 3 cases. BT was well tolerated and associated with clinical improvement in LTRs with MDR bacterial infection not responsive to antibiotics alone. BT may be a viable adjunct to antibiotics for patients with MDR infections.
- Optimizing Energy Expenditure and Oxygenation Toward Ventilator Tolerance is Associated with Lower Ventilator and ICU Days. [Journal Article]
- JTJ Trauma Acute Care Surg 2019 Jun 13
- CONCLUSIONS: Optimizing the patient's nutritional regimen to ventilator tolerance and optimizing oxygenation by means of targeted pulmonary mechanics and inspired FiO2 may be associated with lower ventilator and ICU days as well as overall complication rates.
New Search Next
- Evolving concepts for safer ventilation. [Review]
- CCCrit Care 2019 Jun 14; 23(Suppl 1):114
- Our current understanding of protective measures for avoiding ventilator-induced lung injury (VILI) has evolved from targeting low tidal volumes to lowering plateau and driving pressure. Even when pr…
Our current understanding of protective measures for avoiding ventilator-induced lung injury (VILI) has evolved from targeting low tidal volumes to lowering plateau and driving pressure. Even when pressures across the lung are reliably estimated, however, pressures alone cannot accurately gauge the injury risk; apart from flow rate, inspired oxygen fraction, and currently unmeasurable features of the mechanical microenvironment such as geometry, structural fragility, and vascular perfusion, the frequency with which high-risk tidal cycles are applied must help determine the intensity of potentially damaging energy application. Recognition of a strain threshold for damage by transpulmonary pressure, coupled with considerations of total energy load and strain intensity, has helped shape the unifying concept of VILI generation dependent upon the power transferred from the ventilator to the injured lungs. Currently, under-recognized contributors to the injury process must be addressed to minimize the risk imposed by ventilatory support.