The Impact of New Treatments on Short- and MID-Term Outcomes in Bilateral Lung Transplant: A Propensity Score Study

Boscolo, Annalisa; Amore, Andrea Dell '; Pettenuzzo, Tommaso; Sella, Nicolò; Cassai, Alessandro De; Pistollato, Elisa; Cacco, Nicola; Manzan, Andrea; Carolis, Agnese De; Geraldini, Federico; Lorenzoni, Giulia; Pezzuto, Federica; Zambello, Giovanni; Schiavon, Marco; Calabrese, Fiorella; Gregori, Darío; Rea, Federico; Navalesi, Paolo

doi:10.3390/jcm11195859

Cited by 3 publications

(2 citation statements)

References 39 publications

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“…Weaning from invasive mechanical ventilation has been reported to occur within 72 h in uncomplicated bilateral-lung transplant patients. 12,38 In keeping with these results, the time to extubation was, in our simple weaning subgroup, 29 [23 to 43] h. Nonetheless, the weaning process in bilateral-lung transplant recipients may be affected by various causes, such as diaphragm dysfunction, right ventricular dysfunction, primary graft dysfunction, and perioperative infections. 12,39,40 In our cohort of patients, diaphragm dysfunction was probably associated with difficult weaning (14 of 18 patients), while for the remaining 4 patients, the causes were right ventricular dysfunction (2 patients), primary graft dysfunction (1 patient), and pneumonia (1 patient).…”

Section: Discussionsupporting

confidence: 68%

“…First, it is a single-center study, suffering from the limits of this study design. Worth remarking, however, is that we enrolled a homogeneous cohort of bilateral-lung transplant recipients, 38,39 excluding a priori some well-known risk factors for diaphragm impairment, such as the need for preoperative invasive mechanical ventilation or ECMO, and known phrenic nerve injury. 12,17,18,45 Second, diaphragm ultrasound assessment is inherently operator-dependent and not consistently related to transdiaphragmatic pressure, because of the high interindividual variability in the relationship between diaphragm thickening fraction and pressure generation, [26][27][28][29][30][46][47][48] potentially affected by several factors, such as lung volume, respiratory drive, pain and use of sedatives and/or neuromuscular blocking agents.…”

Section: Diaphragm Dysfunction Weaning In Lung Transplantmentioning

confidence: 99%

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Diaphragm Dysfunction Predicts Weaning Outcome after Bilateral Lung Transplant

et al. 2023

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Background Diaphragm dysfunction and its effects on outcomes of ventilator weaning have been evaluated in mixed critical care populations using diaphragm thickening fraction (TFdi; the ratio of the difference between ultrasound diaphragm thickness at end-inspiration and end-expiration to diaphragm thickness at end-expiration) or neuro-ventilatory efficiency (NVE; the ratio of tidal volume and peak electrical activity of the diaphragm). Such data are not available in bilateral-lung transplant recipients. We hypothesized that: i) diaphragm dysfunction, as defined by a TFdi<29%, is more likely to occur in difficult weaning; ii) TFdi and NVE predict weaning outcome; iii) and duration of mechanical ventilation before the first spontaneous breathing trial (SBT) is associated with diaphragm dysfunction. Methods Adult bilateral-lung transplant patients admitted to our ICU were screened at the time of the first SBT (pressure-support of 5cmH2O and zero positive end-expiratory pressure). At the fifth minute, TFdi and NVE were measured over three respiratory cycles. Weaning was classified as simple, difficult or prolonged (successful extubation at the first SBT, within three or after three SBTs, respectively). Results Forty-four subjects were enrolled. Diaphragm dysfunction occurred in 14 subjects (32%); all of whom had difficult weaning (78% of the subgroup of 18 patients experiencing difficult weaning). Both TFdi (24[20-29] vs 39[35-45]%) and NVE (34[26-45] vs 55[43-62]ml/µV) were lower in difficult weaning (both p<0.001). The areas under the receiver operator curve predicting difficult weaning were 0.88 [95%CI 0.73-0.99] for TFdi, and 0.85 [95%CI 0.71-0.95] for NVE. Duration of ventilation demonstrated a linear inverse correlation with both TFdi and NVE. Conclusions Diaphragm dysfunction is common following bilateral-lung transplantation and associated with difficult weaning. In such patients, average values for TFdi and NVE were reduced compared to patients with simple weaning. Both parameters showed similar accuracy for predicting success of ventilator weaning, demonstrating an inverse relationship with duration of ventilation.

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Section: Discussionsupporting

confidence: 68%

Section: Diaphragm Dysfunction Weaning In Lung Transplantmentioning

confidence: 99%

Diaphragm Dysfunction Predicts Weaning Outcome after Bilateral Lung Transplant

et al. 2023

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Gram-negative bacterial colonizations before bilateral lung transplant. The impact of ‘targeted’ versus ‘standard’ surgical prophylaxis

Congedi,

Peralta,

Muraro

et al. 2024

BMC Infect Dis

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Background Infections are one of the most common causes of death after lung transplant (LT). However, the benefit of ‘targeted’ prophylaxis in LT recipients pre-colonized by Gram-negative (GN) bacteria is still unclear. Methods All consecutive bilateral LT recipients admitted to the Intensive Care Unit of the University Hospital of Padua (February 2016–2023) were retrospectively screened. Only patients with pre-existing GN bacterial isolations were enrolled and analyzed according to the antimicrobial surgical prophylaxis (‘standard’ vs. ‘targeted’ on the preoperative bacterial isolation). Results One hundred eighty-one LT recipients were screened, 46 enrolled. Twenty-two (48%) recipients were exposed to ‘targeted’ prophylaxis, while 24 (52%) to ‘standard’ prophylaxis. Overall prevalence of postoperative multi-drug resistant (MDR) GN bacteria isolation was 65%, with no differences between the two surgical prophylaxis (p = 0.364). Eleven (79%) patients treated with ‘standard’ prophylaxis and twelve (75%) with ‘targeted’ therapy reconfirmed the preoperative GN pathogen (p = 0.999). The prevalence of postoperative infections due to MDR GN bacteria was 50%. Of these recipients, 4 belonged to the ‘standard’ and 11 to the ‘targeted’ prophylaxis (p = 0.027). Conclusions The administration of a ‘targeted’ prophylaxis in LT pre-colonized recipients seemed not to prevent the occurrence of postoperative MDR GN infections.

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Fungal Infections and Colonization after Bilateral Lung Transplant: A Six-Year Single-Center Experience

Boscolo,

Cattelan,

Marinello

et al. 2024

JoF

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Fungal infections (FIs) are one of the leading causes of morbidity and mortality within the first year of lung transplant (LT) in LT recipients (LTRs). Their prompt identification and treatment are crucial for a favorable LTR outcome. The objectives of our study were to assess (i) the FI incidence and colonization during the first year after a bilateral LT, (ii) the risk factors associated with FI and colonization, and (iii) the differences in fungal incidence according to the different prophylactic strategies. All bilateral LTRs admitted to the intensive care unit of Padua University Hospital were retrospectively screened, excluding patients <18 years of age, those who had been re-transplanted, and those who had received ventilation and/or extracorporeal membrane oxygenation before LT. Overall, 157 patients were included. A total of 13 (8%) patients developed FI, and 36 (23%) developed colonization, which was mostly due to Aspergillus spp. We did not identify independent risk factors for FI. Groups of patients receiving different prophylactic strategies reported a similar incidence of both FI and colonization. The incidence of FI and fungal colonization was 8% and 23%, respectively, with no differences between different antifungal prophylaxes or identified predisposing factors. Further studies with larger numbers are needed to confirm our results.

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The Impact of New Treatments on Short- and MID-Term Outcomes in Bilateral Lung Transplant: A Propensity Score Study

Cited by 3 publications

References 39 publications

Diaphragm Dysfunction Predicts Weaning Outcome after Bilateral Lung Transplant

Diaphragm Dysfunction Predicts Weaning Outcome after Bilateral Lung Transplant

Gram-negative bacterial colonizations before bilateral lung transplant. The impact of ‘targeted’ versus ‘standard’ surgical prophylaxis

Fungal Infections and Colonization after Bilateral Lung Transplant: A Six-Year Single-Center Experience

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