Acute and Critical Care

Review Article

Pulmonary
Awakening in extracorporeal membrane oxygenation as a bridge to lung transplantation: Su Hwan Lee; Acute Crit Care. 2022;37(1):26-34. Published online February 22, 2022; DOI: https://doi.org/10.4266/acc.2022.00031

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Although the rate of lung transplantation (LTx), the last treatment option for end-stage lung disease, is increasing, some patients waiting for LTx need a bridging strategy for LTx due to the limited number of available donor lungs. For a long time, mechanical ventilation has been employed as a bridge to LTx because the outcome of using extracorporeal membrane oxygenation (ECMO) as a bridging strategy has been poor. However, the outcome after mechanical ventilation as a bridge to LTx was poor compared with that in patients without bridges. With advances in technology and the accumulation of experience, the outcome of ECMO as a bridge to LTx has improved, and the rate of ECMO use as a bridging strategy has increased over time. However, whether the use of ECMO as a bridge to LTx can achieve survival rates similar to those of non-bridged LTx patients remains controversial. In 2010, one center introduced awake ECMO strategy for LTx bridging, and its use as a bridge to LTx has been showing favorable outcomes to date. Awake ECMO has several advantages, such as maintenance of physical activity, spontaneous breathing, avoidance of endotracheal intubation, and reduced use of sedatives and analgesics, but it may cause serious problems. Nonetheless, several studies have shown that awake ECMO performed by a multidisciplinary team is safe. In cases where ECMO or mechanical ventilation is required due to unavoidable exacerbation in patients awaiting LTx, the application of awake ECMO performed by an appropriately trained ECMO multi-disciplinary team can be useful.

Citations

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Extracorporeal membrane oxygenation as a bridge to lung transplantation: Practice patterns and patient outcomes
Hannah J. Rando, Jonathon P. Fanning, Sung-Min Cho, Bo S. Kim, Glenn Whitman, Errol L. Bush, Steven P. Keller
The Journal of Heart and Lung Transplantation.2024; 43(1): 77. CrossRef
Anesthetic considerations for perioperative ECMO in lung transplantation
Julien Fessler, Jaromir Vajter, Archer Kilbourne Martin
Best Practice & Research Clinical Anaesthesiology.2024; 38(1): 58. CrossRef
Nurses’ Interventions in Minimizing Adult Patient Vulnerability During Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation: An Integrative Review
Nuno Costa, Helga Rafael Henriques, Candida Durao
SAGE Open Nursing.2024;[Epub] CrossRef
Long-Term Follow-Up of Patients Needing Extracorporeal Membrane Oxygenation Following a Critical Course of COVID-19
Samuel Genzor, Pavol Pobeha, Martin Šimek, Petr Jakubec, Jan Mizera, Martin Vykopal, Milan Sova, Jakub Vaněk, Jan Praško
Life.2023; 13(4): 1054. CrossRef
Dangers in using beta-blockers in patients with venovenous extracorporeal membrane oxygenation
Diego Rodríguez Álvarez, Elena Pérez-Costa, Juan José Menéndez Suso
Acute and Critical Care.2022; 37(4): 683. CrossRef

Original Article

Surgery
Risk factors for intensive care unit readmission after lung transplantation: a retrospective cohort study: Hye-Bin Kim, Sungwon Na, Hyo Chae Paik, Hyeji Joo, Jeongmin Kim; Acute Crit Care. 2021;36(2):99-108. Published online April 5, 2021; DOI: https://doi.org/10.4266/acc.2020.01144

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Abstract PDF

Background
Lung transplantation (LT) is an accepted therapeutic modality for end-stage lung disease patients. Intensive care unit (ICU) readmission is a risk factor for mortality after LT, for which consistent risk factors have not been elucidated. Thus, we investigated the risk factors for ICU readmission during index hospitalization after LT, particularly regarding the posttransplant condition of LT patients.
Methods
In this retrospective study, we investigated all adult patients undergoing LT between October 2012 and August 2017 at our institution. We collected perioperative data from electronic medical records such as demographics, comorbidities, laboratory findings, ICU readmission, and in-hospital mortality.
Results
We analyzed data for 130 patients. Thirty-two patients (24.6%) were readmitted to the ICU 47 times during index hospitalization. At the initial ICU discharge, the Sequential Organ Failure Assessment (SOFA) score (odds ratio [OR], 1.464; 95% confidence interval [CI], 1.083−1.978; P=0.013) and pH (OR, 0.884; 95% CI, 0.813−0.962; P=0.004; when the pH value increases by 0.01) were related to ICU readmission using multivariable regression analysis and were still significant after adjusting for confounding factors. Thirteen patients (10%) died during the hospitalization period, and the number of ICU readmissions was a significant risk factor for in-hospital mortality. The most common causes of ICU readmission and in-hospital mortality were infection-related.
Conclusions
The SOFA score and pH were associated with increased risk of ICU readmission. Early postoperative management of these factors and thorough posttransplantation infection control can reduce ICU readmission and improve the prognosis of LT patients.

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The association of the Sequential Organ Failure Assessment score at intensive care unit discharge with intensive care unit readmission in the cardiac intensive care unit
Yonghoon Shin, Ji Hoon Jang, Ryoung-Eun Ko, Soo Jin Na, Chi Ryang Chung, Ki Hong Choi, Taek Kyu Park, Joo Myung Lee, Jeong Hoon Yang
European Heart Journal: Acute Cardiovascular Care.2024; 13(4): 354. CrossRef
Cardiothoracic Transplant Anesthesia: Selected Highlights: Part I—Lung Transplantation
Andrew M. Courtwright, Jagan Devarajan, Ashley Virginia Fritz, Archer Kilbourne Martin, Barbara Wilkey, Sudhakar Subramani, Christopher M. Cassara, Justin N. Tawil, Andrea N. Miltiades, Michael L. Boisen, Brandi A. Bottiger, Angela Pollak, Theresa A. Gelz
Journal of Cardiothoracic and Vascular Anesthesia.2023; 37(6): 884. CrossRef
Status and Risk Factors in Patients Requiring Unplanned Intensive Care Unit Readmission Within 48 Hours: A Retrospective Propensity-Matched Study in China
Yan-Ling Yin, Mei-Rong Sun, Kun Zhang, Yu-Hong Chen, Jie Zhang, Shao-Kun Zhang, Li-Li Zhou, Yan-Shuo Wu, Peng Gao, Kang-Kang Shen, Zhen-Jie Hu
Risk Management and Healthcare Policy.2023; Volume 16: 383. CrossRef
Comment on “Risk factors for intensive care unit readmission after lung transplantation: a retrospective cohort study”
Maida Qazi, Mahnoor Amin
Acute and Critical Care.2023; 38(2): 234. CrossRef
Reply to comment on “Risk factors for intensive care unit readmission after lung transplantation: a retrospective cohort study”
Hye-Bin Kim, Sungwon Na, Hyo Chae Paik, Hyeji Joo, Jeongmin Kim
Acute and Critical Care.2023; 38(2): 236. CrossRef
Predicting outcomes, describing complications and optimising rehabilitation in patients undergoing lung transplantation
Massimiliano Polastri, Gian Maria Paganelli
International Journal of Therapy and Rehabilitation.2023; 30(10): 1. CrossRef

Case Report

Pulmonary
Right ventricular assist device with an oxygenator using extracorporeal membrane oxygenation as a bridge to lung transplantation in a patient with severe respiratory failure and right heart decompensation: Dong Kyu Oh, Tae Sun Shim, Kyung-Wook Jo, Seung-Il Park, Dong Kwan Kim, Sehoon Choi, Geun Dong Lee, Sung-Ho Jung, Pil-Je Kang, Sang-Bum Hong; Acute Crit Care. 2020;35(2):117-121. Published online April 8, 2019; DOI: https://doi.org/10.4266/acc.2018.00416

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Abstract PDF

Right heart decompensation is a fatal complication in patients with respiratory failure, particularly in those transitioned to lung transplantation using veno-venous extracorporeal membrane oxygenation (V-V ECMO). In these patients, veno-arterial (V-A ECMO) or veno-arterialvenous extracorporeal membrane oxygenation (V-AV ECMO) is used to support both cardiac and respiratory function. However, these processes may increase the risk of device-related complications such as bleeding, thromboembolism, and limb ischemia. In the present case, a 64-year-old male patient with idiopathic pulmonary fibrosis developed respiratory failure and commenced treatment with V-V ECMO as a bridge to lung transplantation. Unfortunately, the patient developed right heart decompensation and required both cardiac and respiratory support during treatment with V-V ECMO. Instead of adding arterial cannulation, he was switched to a novel configuration, a right ventricular assist device with an oxygenator (Oxy- RVAD) using ECMO, with drainage cannulation from the femoral vein and return cannulation to the main pulmonary artery. The patient was successfully bridged to lung transplantation without serious complications after 10 days of Oxy-RVAD support. To the best of our knowledge, this is an extreme rare and challenging case of Oxy-RVAD using ECMO in a patient successfully bridged to lung transplantation.

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Asad Ali Usman, Audrey Elizabeth Spelde, Wasim Lutfi, Jacob T. Gutsche, William J. Vernick, Omar Toubat, Salim E. Olia, Edward Cantu, Andrew Courtright, Maria M. Crespo, Joshua Diamond, Mauer Biscotti, Christian A. Bermudez
ASAIO Journal.2024; 70(9): 758. CrossRef
Right Ventricular Assist Device With an Oxygenator for the Management of Combined Right Ventricular and Respiratory Failure: A Systematic Review
Juliette Beaulieu, Christine Vu, Sanjog Kalra, Hamza Ouazani Chahdi, Julie Cousineau, Alexis Matteau, Samer Mansour, E. Marc Jolicoeur, Sabrina Jacques, Bénédicte Nauche, Renata Podbielski, Pasquale Ferraro, Charles Poirier, Brian J. Potter
Canadian Journal of Cardiology.2024; 40(9): 1732. CrossRef
Percutaneous OxyRVAD in a Patient with Severe Respiratory Failure and Right Heart Failure: A Case Report
Ga Young Yoo, June Lee, Seok Beom Hong, Do Yeon Kim
Journal of Chest Surgery.2024; 57(3): 319. CrossRef
Central Venopulmonary Extracorporeal Membrane Oxygenation: Background and Standardized Nomenclature
J. Michael Brewer, Roberto Lorusso, L. Mikael Broman, Steven A. Conrad, Justyna Swol, Marc O. Maybauer
ASAIO Journal.2024; 70(9): e123. CrossRef
Outcomes of Lung Transplantation in Patients With Right Ventricular Dysfunction: A Single-Center Retrospective Analysis Comparing ECMO Configurations in a Bridge-to-Transplant Setting
Su Yeon Lee, Jee Hwan Ahn, Ho Cheol Kim, Tae Sun Shim, Pil-Je Kang, Geun Dong Lee, Se Hoon Choi, Sung-Ho Jung, Seung-Il Park, Sang-Bum Hong
Transplant International.2024;[Epub] CrossRef
Venopulmonary extracorporeal membrane oxygenation for right ventricular support as a bridge to lung transplantation: A narrative review
Phan Quang Thuan, Nguyen Hoai Nam, Nguyen Hoang Dinh
SAGE Open Medicine.2024;[Epub] CrossRef
Early Mobilization for a Patient With a Right Ventricular Assist Device With an Oxygenator
Sheena MacFarlane, Vanessa Lee, Adrienne H. Simonds, Samantha Alvarez, Samantha Carty, Kevin H. Ewers, Victoria R. Kelly, Parker Linden, Amanda L. Moskal
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Pediatric Emergency Medicine Journal.2023; 10(4): 175. CrossRef
Right Ventricular Assist Device With Extracorporeal Membrane Oxygenation for Bridging Right Ventricular Heart Failure to Lung Transplantation: A Single-Center Case Series and Literature Review
Jae Guk Lee, Chuiyong Pak, Dong Kyu Oh, Ho Cheol Kim, Pil-Je Kang, Geun Dong Lee, Se Hoon Choi, Sung-Ho Jung, Sang-Bum Hong
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Cardiology Clinics.2022; 40(1): 129. CrossRef
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ASAIO Journal.2022; 68(12): 1461. CrossRef
Percutaneous Pulmonary Artery Cannulation to Treat Acute Secondary Right Heart Failure While on Veno-venous Extracorporeal Membrane Oxygenation
Kelly M. Ivins-O’Keefe, Michael S. Cahill, Arthur R. Mielke, Michal J. Sobieszczyk, Valerie G. Sams, Phillip E. Mason, Matthew D. Read
ASAIO Journal.2022; 68(12): 1483. CrossRef
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Ahmed M El Banayosy, Aly El Banayosy, Joseph M Brewer, Mircea R Mihu, Jaclyn M Chidester, Laura V Swant, Robert S Schoaps, Ammar Sharif, Marc O Maybauer
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Jae Kyeom Sim, Kyeongman Jeon, Gee Young Suh, Suryeun Chung, Yang Hyun Cho
ASAIO Journal.2021; 67(7): e127. CrossRef
Oxy-right Ventricular Assist Device for Bridging of Right Heart Failure to Lung Transplantation
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Intraoperative Management of Adult Patients on Extracorporeal Membrane Oxygenation: An Expert Consensus Statement From the Society of Cardiovascular Anesthesiologists—Part I, Technical Aspects of Extracorporeal Membrane Oxygenation
Michael A. Mazzeffi, Vidya K. Rao, Jeffrey Dodd-o, Jose Mauricio Del Rio, Antonio Hernandez, Mabel Chung, Amit Bardia, Rebecca M. Bauer, Joseph S. Meltzer, Sree Satyapriya, Raymond Rector, James G. Ramsay, Jacob Gutsche
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Review Articles

Pulmonary
Critical Care before Lung Transplantation: Jin Gu Lee, Moo Suk Park, Su Jin Jeong, Song Yee Kim, Sungwon Na, Jeongmin Kim, Hyo Chae Paik; Acute Crit Care. 2018;33(4):197-205. Published online November 30, 2018; DOI: https://doi.org/10.4266/acc.2018.00367

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Abstract PDF

Lung transplantation is widely accepted as the only viable treatment option for patients with end-stage lung disease. However, the imbalance between the number of suitable donor lungs available and the number of possible candidates often results in intensive care unit (ICU) admission for the latter. In the ICU setting, critical care is essential to keep these patients alive and to successfully bridge to lung transplantation. Proper management in the ICU is also one of the key factors supporting long-term success following transplantation. Critical care includes the provision of respiratory support such as mechanical ventilation (MV) and extracorporeal life support (ECLS). Accordingly, a working knowledge of the common critical care issues related to these unique patients and the early recognition and management of problems that arise before and after transplantation in the ICU setting are crucial for long-term success. In this review, we discuss the management and selection of candidates for lung transplantation as well as existing respiratory support strategies that involve MV and ECLS in the ICU setting.

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Optimizing the prelung transplant candidate
John Pagteilan, Scott Atay
Current Opinion in Organ Transplantation.2024; 29(1): 37. CrossRef
Awakening in extracorporeal membrane oxygenation as a bridge to lung transplantation
Su Hwan Lee
Acute and Critical Care.2022; 37(1): 26. CrossRef
Recipient Management before Lung Transplantation
Hyoung Soo Kim, Sunghoon Park
Journal of Chest Surgery.2022; 55(4): 265. CrossRef
Outcomes of Patients on the Lung Transplantation Waitlist in Korea: A Korean Network for Organ Sharing Data Analysis
Hye Ju Yeo, Dong Kyu Oh, Woo Sik Yu, Sun Mi Choi, Kyeongman Jeon, Mihyang Ha, Jin Gu Lee, Woo Hyun Cho, Young Tae Kim
Journal of Korean Medical Science.2022;[Epub] CrossRef
Long- and short-term clinical impact of awake extracorporeal membrane oxygenation as bridging therapy for lung transplantation
Nam Eun Kim, Ala Woo, Song Yee Kim, Ah Young Leem, Youngmok Park, Se Hyun Kwak, Seung Hyun Yong, Kyungsoo Chung, Moo Suk Park, Young Sam Kim, Ha Eun Kim, Jin Gu Lee, Hyo Chae Paik, Su Hwan Lee
Respiratory Research.2021;[Epub] CrossRef

Pulmonary
Critical Care after Lung Transplantation: Song Yee Kim, Su Jin Jeong, Jin Gu Lee, Moo Suk Park, Hyo Chae Paik, Sungwon Na, Jeongmin Kim; Acute Crit Care. 2018;33(4):206-215. Published online November 30, 2018; DOI: https://doi.org/10.4266/acc.2018.00360

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Abstract PDF

Since the first successful lung transplantation in 1983, there have been many advances in the field. Nevertheless, the latest data from the International Society for Heart and Lung Transplantation revealed that the risk of death from transplantation is 9%. Various aspects of postoperative management, including mechanical ventilation, could affect intensive care unit stay, hospital stay, and immediate postoperative morbidity and mortality. Complications such as reperfusion injury, graft rejection, infection, and dehiscence of anastomosis increase fatal adverse side effects immediately after surgery. In this article, we review the possible immediate complications after lung transplantation and summarize current knowledge on prevention and treatment.

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Aspergillus Galactomannan Titer as a Diagnostic Marker of Invasive Pulmonary Aspergillosis in Lung Transplant Recipients: A Single-Center Retrospective Cohort Study
Eun-Young Kim, Seung-Hyun Yong, Min-Dong Sung, A-La Woo, Young-Mok Park, Ha-Eun Kim, Su-Jin Jung, Song-Yee Kim, Jin-Gu Lee, Young-Sam Kim, Hyo-Chae Paik, Moo-Suk Park
Journal of Fungi.2023; 9(5): 527. CrossRef
Nontuberculous mycobacterial infection after lung transplantation: A single-center experience in South Korea
Youngmok Park, Nam Eun Kim, Se Hyun Kwak, Moo Suk Park, Su Jin Jeong, Jin Gu Lee, Hyo Chae Paik, Song Yee Kim, Young Ae Kang
Journal of Microbiology, Immunology and Infection.2022; 55(1): 123. CrossRef
Medical Complications of Lung Transplantation
Moo Suk Park
Journal of Chest Surgery.2022; 55(4): 338. CrossRef
Roles of electrical impedance tomography in lung transplantation
Hui Jiang, Yijiao Han, Xia Zheng, Qiang Fang
Frontiers in Physiology.2022;[Epub] CrossRef
Perioperative anidulafungin combined with triazole prophylaxis for the prevention of early invasive candidiasis in lung transplant recipients
Emily Sartain, Kelly Schoeppler, Barrett Crowther, Joshua B. Smith, Maheen Z. Abidi, Todd J. Grazia, Mark Steele, Terri Gleason, Krista Porter, Alice Gray
Transplant Infectious Disease.2021;[Epub] CrossRef
The Prediction and Prognosis of Fungal Infection in Lung Transplant Recipients—A Retrospective Cohort Study in South Korea
Yae-Jee Baek, Yun-Suk Cho, Moo-Hyun Kim, Jong-Hoon Hyun, Yu-Jin Sohn, Song-Yee Kim, Su-Jin Jeong, Moo-Suk Park, Jin-Gu Lee, Hyo-Chae Paik
Journal of Fungi.2021; 7(8): 639. CrossRef
Panel-Reactive and Donor-Specific Antibodies before Lung Transplantation can Affect Outcomes in Korean Patients Receiving Lung Transplantation
Sung Woo Moon, Moo Suk Park, Jin Gu Lee, Hyo Chae Paik, Young Tae Kim, Hyun Joo Lee, Samina Park, Sun Mi Choi, Do Hyung Kim, Woo Hyun Cho, Hye Ju Yeo, Seung-il Park, Se Hoon Choi, Sang-Bum Hong, Tae Sun Shim, Kyung-Wook Jo, Kyeongman Jeon, Byeong-Ho Jeong
Yonsei Medical Journal.2020; 61(7): 606. CrossRef
A proof-of principal study using phase-contrast imaging for the detection of large airway pathologies after lung transplantation
Stephan Umkehrer, Carmela Morrone, Julien Dinkel, Laura Aigner, Maximilian F. Reiser, Julia Herzen, Ali Ö. Yildirim, Franz Pfeiffer, Katharina Hellbach
Scientific Reports.2020;[Epub] CrossRef

Original Article

Pulmonary
Feasibility of Immediate in-Intensive Care Unit Pulmonary Rehabilitation after Lung Transplantation: A Single Center Experience: Joo Han Song, Ji-Eun Park, Sang Chul Lee, Sarang Kim, Dong Hyung Lee, Eun Kyoung Kim, Song Yee Kim, Ji Cheol Shin, Jin Gu Lee, Hyo Chae Paik, Moo Suk Park; Acute Crit Care. 2018;33(3):146-153. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00129

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Abstract PDF

Background
Physical function may influence perioperative outcomes of lung transplantation. We investigated the feasibility of a pulmonary rehabilitation program initiated in the immediate postoperative period at an intensive care unit (ICU) for patients who underwent lung transplantation.
Methods
We retrospectively evaluated 22 patients who received pulmonary rehabilitation initiated in the ICU within 2 weeks after lung transplantation at our institution from March 2015 to February 2016. Levels of physical function were graded at the start of pulmonary rehabilitation and then weekly throughout rehabilitation according to criteria from our institutional pulmonary rehabilitation program: grade 1, bedside (G1); grade 2, dangling (G2); grade 3, standing (G3); and grade IV, gait (G4).
Results
The median age of patients was 53 years (range, 25 to 73 years). Fourteen patients (64%) were males. The initial level of physical function was G1 in nine patients, G2 in seven patients, G3 in four patients, and G4 in two patients. Patients started pulmonary rehabilitation at a median of 7.5 days (range, 1 to 29 days) after lung transplantation. We did not observe any rehabilitation-related complications during follow-up. The final level of physical function was G1 in six patients, G3 in two patients, and G4 in 14 patients. Fourteen of the 22 patients were able to walk with or without assistance, and 13 of them maintained G4 until discharge; the eight remaining patients never achieved G4.
Conclusions
Our results suggest the feasibility of early pulmonary rehabilitation initiated in the ICU within a few days after lung transplantation.

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Post-operative, inpatient rehabilitation after lung transplant evaluation (PIRATE): A feasibility randomized controlled trial
Benjamin J Tarrant, Elizabeth Quinn, Rebecca Robinson, Megan Poulsen, Louise Fuller, Greg Snell, Bruce R Thompson, Brenda M Button, Anne E Holland
Physiotherapy Theory and Practice.2023; 39(7): 1406. CrossRef
Early Gait Function After Lung Transplantation in Patients With and Without Pretransplant Extracorporeal Membrane Oxygenation Support
Junghwa Do, Hyojin Lim, Kyung Cheon Seo, Suyoung Park, HyeRin Joo, Junghoon Lee, Eunjae Ko, Jaehwal Lim, Ho Cheol Kim, Dongkyu Oh, Sang-Bum Hong, Won Kim
Transplantation Proceedings.2023; 55(3): 616. CrossRef

Case Report

Pulmonary
Lung Transplantation for Chronic Humidifier Disinfectant-Associated Lung Injury: Won-Young Kim, So-Woon Kim, Kyung-Wook Jo, Sae Hoon Choi, Hyung Ryul Kim, Yong-Hee Kim, Dong Kwan Kim, Seung-Il Park, Sang-Bum Hong; Korean J Crit Care Med. 2016;31(2):146-151. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.146

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Abstract PDF

In the spring of 2011, a cluster of lung injuries caused by humidifier disinfectant (HD) usage were reported in Korea. Many patients required mechanical ventilation, extracorporeal membrane oxygenation, and even lung transplantation (LTPL). However, the long-term course of HD-associated lung injury remains unclear because the majority of survivors recovered normal lung function. Here we report a 33-year-old woman who underwent LTPL approximately four years after severe HD-associated lung injury. The patient was initially admitted to the intensive care unit and was supported by a high-flow nasal cannula. Although she had been discharged, she was recurrently admitted to our hospital due to progressive lung fibrosis and a persistent decline in lung function. Finally, sequential double LTPL was successfully performed, and the patient’s clinical and radiological findings showed significant improvement. Therefore, we conclude that LTPL can be a therapeutic option for patients with chronic inhalation injury.

Citations

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Humidifier Disinfectant-Associated Lung Injury: Six Years after the Tragic Event
Won-Young Kim, Sang-Bum Hong
Tuberculosis and Respiratory Diseases.2017; 80(4): 351. CrossRef

Original Article

Pulmonary/Cardiology
Perioperative Risk Factors associated with Immediate Postoperative Extracorporeal Membrane Oxygenation in Lung Transplants: Ha Yeon Kim, Sungwon Na, Hyo Chae Paik, Jonglin Ha, Jeongmin Kim; Korean J Crit Care Med. 2015;30(4):286-294. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.286

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Abstract PDF

Background
Extracorporeal membrane oxygenation (ECMO) is administered for a few days after lung transplantation (LTx) in recipients who are expected to have early graft dysfunction. Despite its life-saving potential, immediate postoperative ECMO has life-threatening complications such as postoperative bleeding. We investigated the risk factors related to the use of immediate postoperative ECMO.
Methods
We retrospectively reviewed the records of 60 LTx patients who were at our institution from October 2012 to May 2015. Perioperative variables associated with postoperative ECMO were compared between the two groups.
Results
There were 26 patients who received postoperative ECMO (ECMO group) and 34 patients who did not (control group). Multivariate regression analysis revealed preoperative ECMO (odds ratio [OR] 12.55, 95% confidence intervals [CI] 1.34 – 117.24, p = 0.027) and lower peripheral pulse oxymetry saturation (SpO₂) at the end of surgery (OR 0.71, 95% CI 0.54 – 0.95, p = 0.019) were independent risk factors for postoperative ECMO in LTx patients. The incidences of complications, such as re-operation, tracheostomy, renal failure and postoperative atrial fibrillation, were higher in the ECMO group. There was no difference in the duration of postoperative intensive care unit stay or postoperative 30-day mortality between the two groups.
Conclusions
The preoperative ECMO and lower SpO₂ at the end of surgery were associated with postoperative ECMO. Further, postoperative adverse events were higher in the ECMO group compared with the control group. This study suggests that determination of postoperative ECMO requires careful consideration because of the risks of postoperative ECMO in LTx patients.

Citations

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The Future of Research on Extracorporeal Membrane Oxygenation (ECMO)
Ji Young Lee
Korean Journal of Critical Care Medicine.2016; 31(2): 73. CrossRef

Case Reports

Lung Transplantation in Acute Respiratory Distress Syndrome Caused by Influenza Pneumonia: Youjin Chang, Sang Oh Lee, Tae Sun Shim, Sae Hoon Choi, Hyung Ryul Kim, Yong-Hee Kim, Dong Kwan Kim, Seung-Il Park, Sang-Bum Hong; Korean J Crit Care Med. 2015;30(3):196-201. Published online August 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.3.196

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Abstract PDF

Severe acute respiratory distress syndrome (ARDS) is a life-threatening disease with a high mortality rate. Although many therapeutic trials have been performed for improving the mortality of severe ARDS, limited strategies have demonstrated better outcomes. Recently, advanced rescue therapies such as extracorporeal membrane oxygenation (ECMO) made it possible to consider lung transplantation (LTPL) in patients with ARDS, but data is insufficient. We report a 62-year-old man who underwent LTPL due to ARDS with no underlying lung disease. He was admitted to the hospital due to influenza A pneumonia-induced ARDS. Although he was supported by ECMO, he progressively deteriorated. We judged that his lungs were irreversibly damaged and decided he needed to undergo LTPL. Finally, bilateral sequential double-lung transplantation was successfully performed. He has since been alive for three years. Conclusively, we demonstrate that LTPL can be a therapeutic option in patients with severe ARDS refractory to conventional therapies.

Citations

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Lung transplantation for acute respiratory distress syndrome: a retrospective European cohort study
Jens Gottlieb, Philipp M. Lepper, Cristina Berastegui, Beatriz Montull, Alexandra Wald, Jasvir Parmar, Jesper M. Magnusson, Felix Schönrath, Tanel Laisaar, Sebastian Michel, Hillevi Larsson, Robin Vos, Assad Haneya, Tim Sandhaus, Erik Verschuuren, Jérôme
European Respiratory Journal.2022; 59(6): 2102078. CrossRef
Comment on “Lung Transplantation for Elderly Patients With End-Stage COVID-19 Pneumonia”
Michael K. Hsin, See Ching Chan, Huiqing Lin
Annals of Surgery.2021; 274(6): e829. CrossRef

Infection/Pulmonary
Lung Transplantation in a Patient with Pre-transplant Colonization of Extensively Drug-resistant Acinetobacter baumannii: Hwa Young Lee, Hea Yon Lee, Sae Bom Shin, Kab Soo Shin, Bong Woo Lee, Hwan Wook Kim, Seok Lee, Seok Chan Kim; Korean J Crit Care Med. 2015;30(2):103-108. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.103

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Abstract PDF: Colonization of the pre-transplant lung by multidrug-resistant bacteria affects short- and long-term outcomes of lung transplantation. However, there are no case reports on the colonization of a pre-transplant lung by drug-resistant Acinetobacter baumannii. We report a case of extensively drug resistant (XDR) A. baumannii colonization in the tracheobronchial tree that caused severe infectious complications after bilateral lung transplantation. A 23-year-old man diagnosed with bronchiolitis obliterans syndrome (BOS) 4 years earlier with a history of allogenic bone marrow transplantation for acute lymphoblastic leukemia was admitted to the hospital with dyspnea. Due to progressive hypercapnic respiratory failure, long-term mechanical ventilation was started after a tracheostomy was performed, and the patient underwent a bilateral lung transplantation to treat end-stage BOS. After the transplantation, the colonization of XDR A. baumannii caused severe bacterial pneumonia in the early postoperative period. Combined treatment with colistin and meropenem led to recovery from the pneumonia but caused drug-induced renal failure. Because many centers are willing to transplant candidates who are on mechanical ventilation or extracorporeal life support, the incidence of XDR A. baumannii colonization of pretransplant lungs is expected to increase. Further studies are needed to examine pre-transplant management strategies in patients colonized with XDR A. baumannii.

Hematology/Pulmonary
Hemophagocytic Lymphohistiocytosis after Lung Transplantation: Ah Young Leem, Sung Woo Moon, Song Yee Kim, Moo Suk Park, Young Sam Kim, Se Kyu Kim, Joon Chang, Hyo Chae Paik, June Won Cheong, Kyung Soo Chung; Korean J Crit Care Med. 2015;30(1):38-41. Published online February 28, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.1.38

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Abstract PDF: Hemophagocytic lymphohistiocytosis (HLH) is a rare but fatal complication after solid organ transplantation. Acquired forms of HLH are described in association with severe sepsis, autoimmune disorders, malignancy, immune-compromised states, infections, and solid organ transplantation. We experienced a case of hemophagocytic lymphohistiocytosis after bilateral lung transplantation. Leukopenia, thrombocytopenia, and hyperbilirubinemia were noted and became aggravated 50 days after transplantation. Diagnosis of HLH was based on clinical and laboratory findings of splenomegaly, cytopenia, elevated ferritin, elevated interleukin-2 receptor, and hemophagocytosis in bone marrow. Other features such as elevated bilirubin, lactate dehydrogenase, and D-dimer which can be present in HLH were also noted. The patient was immediately treated with etoposide and dexamethasone. Despite aggressive therapy, the patient deteriorated and died. Awareness of the diagnostic criteria of HLH after lung transplantation is important for clinicians.

Original Article

Pulmonary
Predicting Delayed Ventilator Weaning after Lung Transplantation: The Role of Body Mass Index: Sarah Soh, Jin Ha Park, Jeong Min Kim, Min Jung Lee, Shin Ok Koh, Hyo Chae Paik, Moo Suk Park, Sungwon Na; Korean J Crit Care Med. 2014;29(4):273-280. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.273

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Abstract PDF: BACKGROUND
Weaning from mechanical ventilation is difficult in the intensive care unit (ICU). Many controversial questions remain unanswered concerning the predictors of weaning failure. This study investigates patient characteristics and delayed weaning after lung transplantation.
METHODS
This study retrospectively reviewed the medical records of 17 lung transplantation patients from October 2012 to December 2013. Patients able to be weaned from mechanical ventilation within 8 days after surgery were assigned to an early group (n = 9), and the rest of the patients were assigned to the delayed group (n=8). Patients' intraoperative and postoperative characteristics were collected and analyzed, and conventional weaning predictors, including rapid shallow breathing index (RSBI), were also assessed.
RESULTS
The results of the early group showed a significantly shorter ICU stay in addition to a shorter hospitalization overall. Notably, the early group had a higher body mass index (BMI) than the delayed group (20.7 vs. 16.9, p = 0.004). In addition, reopening occurred more frequently in the delayed group (1/9 vs. 5/8, p = 0.05). During spontaneous breathing trials, tidal volume (TV) and arterial oxygen tension were significantly higher in the early group compared to the delayed weaning group, but differences in RSBI and respiratory rate (RR) between groups were not statistically significant.
CONCLUSIONS
Low BMI might be associated with delayed ventilator weaning in lung transplantation patients. In addition, instead of the traditional weaning predictors of RSBI and RR, TV might be a better predictor for ventilator weaning after lung transplantation.

Case Reports

Cardiology/Pulmonary
Dual Extracorporeal Membrane Oxygenation Support for Bridging Lung Transplantation in Acute Exacerbation of Idiopathic Pulmonary Fibrosis: Dong Jung Kim, Yeon Joo Lee, Jun Sung Kim, Sangheon Park, Young Jae Cho; Korean J Crit Care Med. 2014;29(3):207-211. Published online August 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.3.207

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Abstract PDF: When patients with severe respiratory failure are treated with venovenous extracorporeal membrane oxygenation (VV-ECMO), severe pulmonary hypertension due to right ventricular (RV) failure is possible. This is a serious complication that requires immediate therapeutic intervention. We report an extraordinary experience of additional venoarterial extracorporeal membrane oxygenation (VA-ECMO) support for RV failure in a patient who was being treated with VV-ECMO as a bridge to lung transplantation. A 61-year-old man was diagnosed with acute exacerbation of idiopathic pulmonary fibrosis. While waiting for lung transplantation, he was placed on VV-ECMO and developed RV failure. After insertion of additional VA ECMO, RV dysfunction was dramatically improved. He underwent heart-lung transplantation after 23 days of dual ECMO support.

Cardiology/Pulmonary
One Hundred Seven Days of ECMO as a Bridge to Lung Transplantation: The Longest Duration Among Elderly Patients: Eun Jung Kim, Hyo Chae Paik, Moo Suk Park, Myung Hwa Kim, Shin Ok Koh, You Jin Lee, Sungwon Na; Korean J Crit Care Med. 2014;29(1):48-51. Published online February 28, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.1.48

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Abstract PDF

Extracorporeal membrane oxygenation (ECMO) is a means for supporting adequate gas exchange in patients with severe respiratory failure and is the only therapeutic option for ventilation-refractory patients awaiting lung transplantation. Moreover, defining the patients likely to benefit from ECMO as a bridge to transplantation has recently become a point of interest. Here, we report a case of prolonged ECMO support to a patient awaiting lung transplantation. A 66-year-old woman was diagnosed with acute interstitial pneumonia and was placed on veno-venous (VV) ECMO due to unsatisfactory gas exchange despite maximal ventilator care. She underwent bilateral lung transplantation after 99 days of ECMO and was successfully weaned from it on the 107th ECMO day. This is the longest period of ECMO support to be reported among elderly patients.

Citations

Citations to this article as recorded by

Long-Term Venovenous Connection for Extracorporeal Carbon Dioxide Removal (ECCO2R)–Numerical Investigation of the Connection to the Common Iliac Veins
N. B. Steuer, K. Hugenroth, T. Beck, J. Spillner, R. Kopp, S. Reinartz, T. Schmitz-Rode, U. Steinseifer, G. Wagner, J. Arens
Cardiovascular Engineering and Technology.2020; 11(4): 362. CrossRef
One hundred forty six days on extracorporeal membrane oxygenation (ECMO): Our longest ECMO run
Ahmad Said Abdalmohsen Ali, Mohamed Yosri, Mohamed Abouelwafa, Mahmoud Saad, Kareem Zaki, Shady Mashhour, Husam Salah, Tarek Mohsen, Amaany Abozeid, Mohamed Khaled, Akram Abdelbary, Alia Abdelfattah
The Egyptian Journal of Critical Care Medicine.2018; 6(3): 113. CrossRef
Recovery from Acute Respiratory Distress Syndrome with Long-Run Extracorporeal Membrane Oxygenation
Jin Jeon, Jin Won Huh, Chae-Man Lim, Younsuck Koh, Sang-Bum Hong
Korean Journal of Critical Care Medicine.2014; 29(3): 212. CrossRef

A Case of Burkholderia cepacia Pneumonia after Lung Transplantation in a Recipient without Cystic Fibrosis: Jin Sun Cho, Sungwon Na, Moo Suk Park, Yun So, Bahn Lee, Shin Ok Koh, Hyo Chae Paik; Korean J Crit Care Med. 2013;28(3):187-191.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.187

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Abstract PDF

Burkholderia cepacia is a highly virulent pathogen known to cause opportunistic infections in immunocompromised patients. It accelerates lung disease and causes necrotizing pneumonia with associated severe sepsis, known as cepacia syndrome. In particular, lung transplant recipients infected with Burkholderia cepacia show higher mortality after lung transplantation than those who are not infected with this organism. Due to broad-spectrum antibiotic resistance, a combination therapy should be used according to the results of the susceptibility test. This bacterial infection is rare in Korea, and no case was reported in lung transplant recipients. However, we report a case of pneumonia caused by Burkholderia cepacia after lung transplantation. As Burkholderia cepacia was grown from a sputum culture, the patient was treated initially with a combination of meropenem and trimethoprim/sulfamethoxazole and then ceftazidime and trimethoprim/sulfamethoxazole as a result of leukopenia. After antibiotics treatment for 20 days, sputum cultures became negative for Burkholderia cepacia and the patient successfully recovered.

Citations

Citations to this article as recorded by

Current perspective of lung transplantation
Hyo Chae Paik
Journal of the Korean Medical Association.2016; 59(2): 119. CrossRef

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