140 results found
Senturk M, El Tahan MR, Szegedi LL, et al., 2020, Thoracic Anesthesia of Patients With Suspected or Confirmed 2019 Novel Coronavirus Infection: Preliminary Recommendations for Airway Management by the European Association of Cardiothoracic Anaesthesiology Thoracic Subspecialty Committee, JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, Vol: 34, Pages: 2315-2327, ISSN: 1053-0770
Erdoes G, Vuylsteke A, Schreiber J-U, et al., 2020, European Association of Cardiothoracic Anesthesiology (EACTA) Cardiothoracic and Vascular Anesthesia Fellowship Curriculum: First Edition, JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, Vol: 34, Pages: 1132-1141, ISSN: 1053-0770
Cummings IG, Lucchese G, Garg S, et al., 2020, Ten-year improved survival in patients with multi-vessel coronary disease and poor left ventricular function following surgery: A retrospective cohort study., Int J Surg, Vol: 76, Pages: 146-152
OBJECTIVE: Patients with multi-vessel coronary artery disease and poor left ventricular (LV) function (ejection fraction [EF] < 30%) requiring revascularization are considered 'high-risk'. Limited long-term survival data exists comparing percutaneous coronary intervention (PCI) with second-generation drug-eluting stents (DES) versus surgery for this cohort of patients. METHODS: We retrospectively reviewed our data for 321 patients with EF < 30% who underwent multi-vessel revascularization from January 2005 to December 2015 using Cox regression analyses and inverse probability treatment weighted (IPTW) methods. We stratified patients that underwent surgical revascularization into on-pump coronary artery bypass grafting (CABG) and off-pump CABG and analyzed all-cause mortality at 10 years compared to PCI. RESULTS: 214 patients underwent CABG (n [on-pump CABG] = 94; n [off-pump CABG] = 120) and 107 patients had PCI with second generation DES. PCI with DES had higher 10-year mortality compared with on-pump CABG (Hazard ratio [HR] = 1.86, 95% confidence interval [CI] = 1.46-2.42; p < 0.001) and off-pump CABG (HR = 2.32, 95% CI = 1.75-3.15; p < 0.001). This was confirmed in IPTW analyses. When adjusting for both measured and unmeasured factors using instrumental variable analyses, PCI with DES had higher 10-year mortality compared with on-pump CABG (Δ = 13.5, 95% CI = 3.2-24.5; p = 0.012) and off-pump CABG (Δ = 16.1, 95% CI = 5.9-25.8; p < 0.001). CONCLUSION: Surgical revascularization, preferably off-pump CABG, results in better long-term survival compared with PCI using second generation DES for patients with multi-vessel coronary artery disease and poor left ventricular function. Randomized controlled trials in this patient group should be undertaken.
Marczin N, Romano R, Scaramuzzi M, 2020, Lung transplantation: Justification for a paradigm change, Anesthesia in Thoracic Surgery: Changes of Paradigms, Pages: 277-287, ISBN: 9783030285272
Although lung transplantation (LTx) has moved from experimental surgical options to established therapy with increasing worldwide activity, growing recipient waiting lists and improving outcomes, it remains limited by donor shortages, high perioperative morbidity and mortality and the lowest long-term survival of all solid organ transplants. Unfortunately, development of severe Primary Graft Dysfunction (PGD) remains too prevalent and nonpulmonary complications are nearly ubiquitous with both negatively effecting long term patient survival and quality of life. Such analysis highlights the need for anaesthesia and intensive care to take better ownership of the total morbidity burden and perioperative and consequent long-term mortality. It also calls for constant quality improvement and ongoing critical appraisal of our management goals to understand better and to exploit new opportunities to reduce complications, enhance perioperative patient journey and ultimately to improve both short- and long-term survival of lung transplant recipients. This chapter provides insights into the major paradigm shifts in our anaesthesia mission and regarding some of the principle intraoperative and postoperative management strategies. These are underpinned with exciting new basic research progress regarding the leukocyte theory and cytokine concepts of acute lung injury in the setting of LTx.
Kiss T, Wittenstein J, Becker C, et al., 2019, Protective ventilation with high versus low positive end-expiratory pressure during one-lung ventilation for thoracic surgery (PROTHOR): study protocol for a randomized controlled trial (vol 20, 213, 2019), TRIALS, Vol: 20, ISSN: 1745-6215
Kiss T, Wittenstein J, Becker C, et al., 2019, Protective ventilation with high versus low positive end-expiratory pressure during one-lung ventilation for thoracic surgery (PROTHOR): study protocol for a randomized controlled trial, TRIALS, Vol: 20, ISSN: 1745-6215
Ampatzidou F, Boutou AK, Karagounis L, et al., 2019, Noninvasive Ventilation to Treat Respiratory Failure After Cardiac Surgery: Predictors of Application and Outcome., Respir Care
BACKGROUND: Respiratory complications remain a major cause of morbidity in cardiac surgery patients. This study aimed to determine the prognostic parameters associated with the application of noninvasive ventilation (NIV) for the treatment of acute respiratory failure, along with the possible predictors associated with NIV failure, among the subjects who underwent cardiac surgery. METHODS: This was a retrospective cohort study. Data on all adult patients who underwent cardiac surgery in a single center between May 2012 and December 2016 were analyzed. Multivariate regression analysis with bootstrapping was used to identify which baseline and intraoperative parameters were associated with the application of NIV to treat acute postoperative respiratory failure. A univariate analysis was also applied to identify potential variables associated with NIV failure. P < .05 was considered significant. RESULTS: A total of 1,657 subjects (mean ± SD age 65.2 ± 10.7 y; 21.7% females) constituted the study population, 145 (8.8%) of whom were treated with NIV due to acute postoperative respiratory failure. Body mass index adjusted odds ratio 1.02, bias-corrected 95% CI 1.01-1.04), EuroSCORE (European System for Cardiac Operative Risk Evaluation) II (adjusted odds ratio 1.11, bias-corrected 95% CI 1.02-1.32), COPD (adjusted odds ratio 4.004, bias-corrected 95% CI 2.53-8.93), and preoperative estimated glomerular filtration rate (adjusted odds ratio 0.99, bias-corrected 95% CI 0.98-0.99) independently predicted NIV application. NIV treatment failed in 16 of the 145 subjects (11%) and age, EuroSCORE II, COPD, heart failure, renal replacement therapy, and postoperative stroke were all univariately associated with the outcome. CONCLUSIONS: NIV successfully treated acute respiratory failure in the vast majority of cardiac surgery subjects and COPD, EuroSCORE II, body mass index, and preoperative renal function were independently associated with its application.
de Waal EEC, van Zaane B, van der Schoot MM, et al., 2018, Vasoplegia after implantation of a continuous flow left ventricular assist device: incidence, outcomes and predictors, BMC ANESTHESIOLOGY, Vol: 18, ISSN: 1471-2253
Henderson B, Khodabakhsh A, Metsala M, et al., 2018, Laser spectroscopy for breath analysis: towards clinical implementation, APPLIED PHYSICS B-LASERS AND OPTICS, Vol: 124, ISSN: 0946-2171
Ananiadou O, Schmack B, Zych B, et al., 2018, Suicidal hanging donors for lung transplantation: Is this chapter still closed? Midterm experience from a single center in United Kingdom, MEDICINE, Vol: 97, ISSN: 0025-7974
Romano R, Cristescu SM, Risby TH, et al., 2018, Lipid peroxidation in cardiac surgery: towards consensus on biomonitoring, diagnostic tools and therapeutic implementation, JOURNAL OF BREATH RESEARCH, Vol: 12, ISSN: 1752-7155
Tatham KC, O'Dea KP, Romano R, et al., 2018, Intravascular donor monocytes play a central role in lung transplant ischaemia-reperfusion injury, Thorax, Vol: 73, Pages: 350-360, ISSN: 1468-3296
Rationale Primary graft dysfunction in lung transplant recipients derives from the initial, largely leukocyte-dependent, ischaemia-reperfusion injury. Intravascular lung-marginated monocytes have been shown to play key roles in experimental acute lung injury, but their contribution to lung ischaemia-reperfusion injury post transplantation is unknown.Objective To define the role of donor intravascular monocytes in lung transplant-related acute lung injury and primary graft dysfunction.Methods Isolated perfused C57BL/6 murine lungs were subjected to warm ischaemia (2 hours) and reperfusion (2 hours) under normoxic conditions. Monocyte retention, activation phenotype and the effects of their depletion by intravenous clodronate-liposome treatment on lung inflammation and injury were determined. In human donor lung transplant samples, the presence and activation phenotype of monocytic cells (low side scatter, 27E10+, CD14+, HLA-DR+, CCR2+) were evaluated by flow cytometry and compared with post-implantation lung function.Results In mouse lungs following ischaemia-reperfusion, substantial numbers of lung-marginated monocytes remained within the pulmonary microvasculature, with reduced L-selectin and increased CD86 expression indicating their activation. Monocyte depletion resulted in reductions in lung wet:dry ratios, bronchoalveolar lavage fluid protein, and perfusate levels of RAGE, MIP-2 and KC, while monocyte repletion resulted in a partial restoration of the injury. In human lungs, correlations were observed between pre-implantation donor monocyte numbers/their CD86 and TREM-1 expression and post-implantation lung dysfunction at 48 and 72 hours.Conclusions These results indicate that lung-marginated intravascular monocytes are retained as a ‘passenger’ leukocyte population during lung transplantation, and play a key role in the development of transplant-associated ischaemia-reperfusion injury.
Zeriouh M, Sabashnikov A, Patil NP, et al., 2018, Use of taurolidine in lung transplantation for cystic fibrosis and impact on bacterial colonization, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 53, Pages: 603-609, ISSN: 1010-7940
Tomasi R, Betz D, Schlager S, et al., 2018, Intraoperative Anesthetic Management of Lung Transplantation: Center-Specific Practices and Geographic and Centers Size Differences, JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, Vol: 32, Pages: 62-69, ISSN: 1053-0770
Boshier PR, Knaggs AL, Hanna GB, et al., 2017, Perioperative changes in exhaled nitric oxide during oesophagectomy, JOURNAL OF BREATH RESEARCH, Vol: 11, ISSN: 1752-7155
Boshier PRB, Knaggs A, Hanna G, et al., 2017, Perioperative changes in exhaled Nitric Oxide during oesophagectomy Dear Mr Boshier, ESDE meeting 2017
El Tahan MR, Pasin L, Marczin N, et al., 2017, Impact of Low Tidal Volumes During One-Lung Ventilation. A Meta-Analysis of Randomized Controlled Trials, JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA, Vol: 31, Pages: 1767-1773, ISSN: 1053-0770
ObjectivesThe link between ventilation strategies and perioperative outcomes remains one of the fundamental paradigms of thoracic anaesthesia. During one-lung ventilation (OLV), one lung is excluded from gas exchange and ventilation is directed at the dependent lung. The authors hypothesised that the use of low tidal volumes (VT) during OLV provides adequate gas exchange and improves postoperative outcome.DesignMeta-analysis of randomized clinical trials.SettingThoracic surgery.ParticipantsPatients undergoing OLV.InterventionsNone.Measurements and Main ResultsThe authors performed a meta-analysis of all randomized trials on low versus high VT during OLV in patients undergoing thoracic surgery. Outcomes of the study were gas exchange and airway pressures during and after OLV, postoperative pulmonary complications (PPCs), and hospital stay (HLOS). Fourteen randomized trials were selected, but only a few of them contained one outcome of interest. Low VT was associated with lower arterial oxygen tension, lower airway pressures, and higher arterial carbon dioxide tension at specific time points during OLV. Low VT was associated with preserved gas exchange after OLV, lower incidence of pulmonary infiltrations, and acute respiratory distress syndrome. Incidences of PPCs and HLOS were similar.ConclusionsThe use of low VT reduces airway pressure but worsens gas exchange during OLV. Preservation of postoperative oxygenation and reduction in infiltrates suggest a lung-protective modality with no demonstrable impact on PPCs and HLOS.
Paardekooper LM, van den Bogaart G, Kox M, et al., 2017, Ethylene, an early marker of systemic inflammation in humans, SCIENTIFIC REPORTS, Vol: 7, ISSN: 2045-2322
Ethylene is a major plant hormone mediating developmental processes and stress responses to stimuli such as infection. We show here that ethylene is also produced during systemic inflammation in humans and is released in exhaled breath. Traces of ethylene were detected by laser spectroscopy both in vitro in isolated blood leukocytes exposed to bacterial lipopolysaccharide (LPS) as well as in vivo following LPS administration in healthy volunteers. Exposure to LPS triggers formation of ethylene as a product of lipid peroxidation induced by the respiratory burst. In humans, ethylene was detected prior to the increase of blood levels of inflammatory cytokines and stress-related hormones. Our results highlight that ethylene release is an early and integral component of in vivo lipid peroxidation with important clinical implications as a breath biomarker of bacterial infection.
von Dossow V, Costa J, D'Ovidio F, et al., 2017, Worldwide trends in heart and lung transplantation: Guarding the most precious gift ever, BEST PRACTICE & RESEARCH-CLINICAL ANAESTHESIOLOGY, Vol: 31, Pages: 141-152, ISSN: 1521-6896
Andreasson ASI, Borthwick LA, Gillespie C, et al., 2017, The role of interleukin-1β as a predictive biomarker and potential therapeutic target during clinical ex vivo lung perfusion, Journal of Heart and Lung Transplantation, Vol: 36, Pages: 985-995, ISSN: 1053-2498
BACKGROUND: Extended criteria donor lungs deemed unsuitable for immediate transplantation can be reconditioned using ex vivo lung perfusion (EVLP). Objective identification of which donor lungs can be successfully reconditioned and will function well post-operatively has not been established. This study assessed the predictive value of markers of inflammation and tissue injury in donor lungs undergoing EVLP as part of the DEVELOP-UK study. METHODS: Longitudinal samples of perfusate, bronchoalveolar lavage, and tissue from 42 human donor lungs undergoing clinical EVLP assessments were analyzed for markers of inflammation and tissue injury. Levels were compared according to EVLP success and post-transplant outcomes. Neutrophil adhesion to human pulmonary microvascular endothelial cells (HPMECs) conditioned with perfusates from EVLP assessments was investigated on a microfluidic platform. RESULTS: The most effective markers to differentiate between in-hospital survival and non-survival post-transplant were perfusate interleukin (IL)-1β (area under the curve = 1.00, p = 0.002) and tumor necrosis factor-α (area under the curve = 0.95, p = 0.006) after 30 minutes of EVLP. IL-1β levels in perfusate correlated with upregulation of intracellular adhesion molecule-1 in donor lung vasculature (R(2) = 0.68, p < 0.001) and to a lesser degree upregulation of intracellular adhesion molecule-1 (R(2) = 0.30, p = 0.001) and E-selectin (R(2) = 0.29, p = 0.001) in conditioned HPMECs and neutrophil adhesion to conditioned HPMECs (R(2) = 0.33, p < 0.001). Neutralization of IL-1β in perfusate effectively inhibited neutrophil adhesion to conditioned HPMECs (91% reduction, p = 0.002). CONCLUSIONS: Donor lungs develop a detectable and discriminatory pro-inflammatory signature in perfusate during EVLP. Blocking the IL-1β pathway during EVLP may reduce endothelial activation and subsequent neutrophil adhesion on reperfusion; this requires further investigation i
Zych B, Garcia-Saez D, Ananiadou O, et al., 2017, 10 Years Experience with Maastricht Category III Donation After Circulatory Death (DCD) in Lung Transplantation (LTx) - Analysis of Early and Long-Term Results in Large Single-Centre Cohort, 37th Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation (ISHLT), Publisher: ELSEVIER SCIENCE INC, Pages: S144-S144, ISSN: 1053-2498
Thakuria L, Romano R, Goss V, et al., 2017, Surfactant Metabolism During Normothermic Ex Vivo Lung Perfusion, 37th Annual Meeting and Scientific Sessions of the International-Society-for-Heart-and-Lung-Transplantation (ISHLT), Publisher: ELSEVIER SCIENCE INC, Pages: S91-S91, ISSN: 1053-2498
Fisher A, Andreasson A, Chrysos A, et al., 2016, An observational study of Donor Ex Vivo Lung Perfusion in UK lung transplantation: DEVELOP-UK., Health Technol Assess, Vol: 20, Pages: 1-276
BACKGROUND: Many patients awaiting lung transplantation die before a donor organ becomes available. Ex vivo lung perfusion (EVLP) allows initially unusable donor lungs to be assessed and reconditioned for clinical use. OBJECTIVE: The objective of the Donor Ex Vivo Lung Perfusion in UK lung transplantation study was to evaluate the clinical effectiveness and cost-effectiveness of EVLP in increasing UK lung transplant activity. DESIGN: A multicentre, unblinded, non-randomised, non-inferiority observational study to compare transplant outcomes between EVLP-assessed and standard donor lungs. SETTING: Multicentre study involving all five UK officially designated NHS adult lung transplant centres. PARTICIPANTS: Patients aged ≥ 18 years with advanced lung disease accepted onto the lung transplant waiting list. INTERVENTION: The study intervention was EVLP assessment of donor lungs before determining suitability for transplantation. MAIN OUTCOME MEASURES: The primary outcome measure was survival during the first 12 months following lung transplantation. Secondary outcome measures were patient-centred outcomes that are influenced by the effectiveness of lung transplantation and that contribute to the health-care costs. RESULTS: Lungs from 53 donors unsuitable for standard transplant were assessed with EVLP, of which 18 (34%) were subsequently transplanted. A total of 184 participants received standard donor lungs. Owing to the early closure of the study, a non-inferiority analysis was not conducted. The Kaplan-Meier estimate of survival at 12 months was 0.67 [95% confidence interval (CI) 0.40 to 0.83] for the EVLP arm and 0.80 (95% CI 0.74 to 0.85) for the standard arm. The hazard ratio for overall 12-month survival in the EVLP arm relative to the standard arm was 1.96 (95% CI 0.83 to 4.67). Patients in the EVLP arm required ventilation for a longer period and stayed longer in an intensive therapy unit (ITU) than patients in the standard arm, but duration of overal
Padukone A, Sayeed AK, Marczin N, et al., 2016, Salvage myocardial revascularisation in spontaneous left main coronary artery dissection with cardiogenic shock - the role of mechanical circulatory support, PERFUSION-UK, Vol: 32, Pages: 171-173, ISSN: 0267-6591
Romano R, Thakuria L, Sheibani S, et al., 2016, Inflammatory response following DCD and DBD lung transplantation, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Romano R, Thakuria L, Sheibani S, et al., 2016, Does perfusion with the organ care system influence inflammatory response in lung transplantation?, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Lees NJ, Rosenberg AJP, Hurtado-Doce AI, et al., 2016, Combination of ECMO and cytokine adsorption therapy for severe sepsis with cardiogenic shock and ARDS due to Panton-Valentine leukocidin-positive Staphylococcus aureus pneumonia and H1N1, JOURNAL OF ARTIFICIAL ORGANS, Vol: 19, Pages: 399-402, ISSN: 1434-7229
Tatham KC, O'Dea KP, Romana R, et al., 2016, Retention And Activation Of Donor Vascular Monocytes In Transplanted Lungs Suggests A Central Role In Primary Graft Dysfunction, American Thoracic Society Conference 2016
Tatham KC, O'Dea KP, Romano R, et al., 2016, Retention And Activation Of Donor Vascular Monocytes In Transplanted Lungs Suggests A Central Role In Primary Graft Dysfunction, International Conference of the American-Thoracic-Society (ATS), Publisher: AMER THORACIC SOC, ISSN: 1073-449X
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