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1.
ObjectiveThe use of mechanical circulatory support (MCS) in lung transplantation has been steadily increasing over the prior decade, with evolving strategies for incorporating support in the preoperative, intraoperative, and postoperative settings. There is significant practice variability in the use of these techniques, however, and relatively limited data to help establish institutional protocols. The objective of the AATS Clinical Practice Standards Committee (CPSC) expert panel was to review the existing literature and establish recommendations about the use of MCS before, during, and after lung transplantation.MethodsThe AATS CPSC assembled an expert panel of 16 lung transplantation physicians who developed a consensus document of recommendations. The panel was broken into subgroups focused on preoperative, intraoperative, and postoperative support, and each subgroup performed a focused literature review. These subgroups formulated recommendation statements for each subtopic, which were evaluated by the entire group. The statements were then developed via discussion among the panel and refined until consensus was achieved on each statement.ResultsThe expert panel achieved consensus on 36 recommendations for how and when to use MCS in lung transplantation. These recommendations included the use of veno-venous extracorporeal membrane oxygenation (ECMO) as a bridging strategy in the preoperative setting, a preference for central veno-arterial ECMO over traditional cardiopulmonary bypass during the transplantation procedure, and the benefit of supporting selected patients with MCS postoperatively.ConclusionsAchieving optimal results in lung transplantation requires the use of a wide range of strategies. MCS provides an important mechanism for helping these critically ill patients through the peritransplantation period. Despite the complex nature of the decision making process in the treatment of these patients, the expert panel was able to achieve consensus on 36 recommendations. These recommendations should provide guidance for professionals involved in the care of end-stage lung disease patients considered for transplantation.  相似文献   
2.

Introduction

Left ventricular (LV) dysfunction is estimated to occur in 10%–25% of the general intensive care unit (ICU) population and is frequently seen as regional wall motion abnormalities (RWMAs). Although RWMA is mostly attributed to myocardial ischemia or infarction, some studies have suggested that nonischemic RWMA might also be prevalent. We sought to establish that RWMA can be seen in critically ill patients with normal coronary arteries and to explore reasons for RWMA in this population.

Methods

In this retrospective study, data from the hospital angiography register and the ICU register were collated between 2012 and 2019. Patients were identified who underwent angiography in conjunction with their ICU stay and had RWMA on echocardiography. Patients were divided into either those with non-obstructed or those with obstructed coronary arteries. Cardiac magnetic resonance imaging (cMRI) examinations were reviewed if they had been performed on patients with non-obstructed coronaries.

Results

We identified 53 patients with RWMA and non-obstructed coronary arteries and 204 patients with RWMA and obstructed coronary arteries. Patients with non-obstructed coronary arteries were more often female, younger, and had fewer cardiovascular risk factors. They less commonly had ST elevation, but more frequently had T-wave inversion or serious arrhythmias. Troponin levels were higher in patients with obstructed coronary arteries, but NT-proBNP was similar between the groups. There were no differences in risk-adjusted 90-day mortality between patients with non-obstructed versus obstructed coronary arteries (OR 1.21, [95% CI 0.56–2.64], p = .628). In those with non-obstructed coronary arteries, follow-up echocardiography was available for 38 patients, of whom 30 showed normalization of cardiac function. Of the 14 patients with non-obstructed coronary arteries on whom cMRI was performed, 7 had a tentative diagnosis of Takotsubo syndrome or myocardial stunning; 4 had a myocardial infarction (preexisting in 3 cases); 1 patient had acute myocarditis; 1 patient had post-myocarditis; and 1 patient was diagnosed with dilated cardiomyopathy.

Conclusion

RWMA can be seen to occur in critically ill patients in the absence of coronary artery obstruction. Several conditions can cause regional hypokinesia, and cMRI is useful to evaluate the underlying etiology.  相似文献   
3.
目的探讨经胸超声心动图(TTE)和经胸右心声学造影(C-TTE)对肝硬化伴食管胃底静脉曲张内镜下治疗效果是否有预测价值。 方法前瞻性选取2020年5月至2021年3月在四川省人民医院行首次食管胃底静脉曲张内镜下治疗并完成完整随访的26例肝硬化失代偿期患者。根据内镜下序贯治疗次数将患者分为2组:治疗次数≥3次或转介入、外科手术治疗的为内镜下治疗效果不佳组(14例);治疗次数<3次的为内镜下治疗效果良好组(12例)。比较分析2组患者的一般资料、术前生化指标、食管胃底静脉曲张及治疗情况,以及术前TTE和C-TTE参数。 结果治疗效果良好组与治疗效果不佳组术前生化指标、TTE参数比较,差异均无统计学意义(P均>0.05)。2组患者食管静脉曲张范围比较,差异存在统计学意义(P<0.05),2组均以中下段食管静脉曲张占比最多,治疗效果不佳组该比例更高(85.71% vs 41.67%)。术前C-TTE显示治疗效果不佳组有78.57%存在右向左分流(RLS)(心内水平2例,心外水平8例,心内合并心外1例),中量及以上占比达50.00%;而治疗效果良好组仅33.33%存在RLS(心内水平1例,心外水平3例),中量及以上占比约16.67%。治疗效果不佳组RLS的发生率高于治疗效果良好组(χ2=5.418,P=0.020),中量及以上分流量占比也高于治疗效果良好组。 结论通过C-TTE明确是否伴发心内和(或)心外水平RLS,可能有助于预测肝硬化伴食管胃底静脉曲张内镜下治疗的效果,C-TTE对其治疗效果预估可能有一定指导价值。  相似文献   
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