Pulmonary Hypertensive Crisis on Induction of Anesthesia

2016 ◽  
Vol 21 (1) ◽  
pp. 105-113 ◽  
Author(s):  
Travis Schisler ◽  
Jose M Marquez ◽  
Ibtesam Hilmi ◽  
Kathirvel Subramaniam
Keyword(s):  
Pulmonary Hypertension ◽  
Lung Transplantation ◽  
Hypertensive Crisis ◽  
Positive Pressure ◽  
Metabolic Dysfunction ◽  
Anesthetic Induction ◽  
Severe Hypotension ◽  
Risk Patients ◽  
Pulmonary Hypertensive Crisis ◽  
End Stage

Anesthesia for lung transplantation remains one of the highest risk surgeries in the domain of the cardiothoracic anesthesiologist. End-stage lung disease, pulmonary hypertension, and right heart dysfunction as well as other comorbid disease factors predispose the patient to cardiovascular, respiratory and metabolic dysfunction during general anesthesia. Perhaps the highest risk phase of surgery in the patient with severe pulmonary hypertension is during the induction of anesthesia when the removal of intrinsic sympathetic tone and onset of positive pressure ventilation can decompensate a severely compromised cardiovascular system. Severe hypotension, cardiac arrest, and death have been reported previously. Here we present 2 high-risk patients for lung transplantation, their anesthetic induction course, and outcomes. We offer suggestions for the safe management of anesthetic induction to mitigate against hemodynamic and respiratory complications.

Pulmonary Hypertension in End-Stage Pulmonary Fibrosis: Prevalence, Predictors and Survival before and after Lung Transplantation

2013 ◽  
Vol 32 (4) ◽  
pp. S18-S19 ◽  
Author(s):  
L. Bjurström ◽  
K.H. Andersen ◽  
J. Kjærgaard ◽  
M.P. Iversen ◽  
S. Boesgaard ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Fibrosis ◽  
Lung Transplantation ◽  
Before And After ◽  
End Stage

Heart-lung transplantation is the method of choice in the treatment of patients with end-stage pulmonary hypertension

2002 ◽  
Vol 34 (6) ◽  
pp. 2181-2182 ◽  
Author(s):  
U.F.W Franke ◽  
T Wahlers ◽  
T Wittwer ◽  
T Franke ◽  
J Niedermeyer ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Lung Transplantation ◽  
End Stage

Inhaled Nitric Oxide Used as a Bridge to Heart-Lung Transplantation in a Patient with End-stage Pulmonary Hypertension

1995 ◽  
Vol 151 (4) ◽  
pp. 1263-1266
Author(s):  
Gregory I. Snell ◽  
Robert F. Salamonsen ◽  
Peter Bergin ◽  
Donald S. Esmore ◽  
Shant Khan ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Pulmonary Hypertension ◽  
Lung Transplantation ◽  
Inhaled Nitric Oxide ◽  
End Stage

Dead space ratio as a tool in nitric oxide weaning: a study in pulmonary hypertensive disease

2021 ◽  
pp. 1-5
Author(s):  
Alvaro D. Garcia ◽  
Wei Liu ◽  
William J. Hanna ◽  
Hemant Agarwal
Keyword(s):  
Nitric Oxide ◽  
Pulmonary Hypertension ◽  
Dead Space ◽  
Hypertensive Crisis ◽  
Inhaled Nitric Oxide ◽  
Successful Weaning ◽  
Cardiac Intensive Care ◽  
Pulmonary Hypertensive Crisis ◽  
Nitric Oxide Therapy ◽  
Space Ratio

Abstract Objectives: To describe the association between successful weaning of inhaled nitric oxide and trends in dead space ratio during such weans in patients empirically initiated on nitric oxide therapy out of concern of pulmonary hypertensive crisis. Patients: Children in a cardiac intensive care unit initiated on inhaled nitric oxide out of clinical concern for pulmonary hypertensive crisis retrospectively over 2 years. Measurements and Main Results: Twenty-seven patients were included, and nitric oxide was successfully discontinued in 23/27. These patients exhibited decreases in dead space ratio (0.18 versus 0.11, p = 0.047) during nitric oxide weaning, and with no changes in dead space ratio between pre- and post-nitric oxide initiation (p = 0.88) and discontinuation (p = 0.63) phases. These successful patients had a median age of 10 months [4.0, 57.0] and had a pre-existent diagnosis of CHD in 6/23 and pulmonary hypertension in 2/23. Those who failed nitric oxide discontinuation trended with a higher dead space ratio at presentation (0.24 versus 0.10), were more likely to carry a prior diagnosis of pulmonary hypertension (50% versus 8.7%), and had longer mechanical ventilation days (5 versus 12). Conclusions: Patients empirically placed on nitric oxide out of concern of pulmonary hypertensive crisis and successfully weaned off showed unchanged or decreased dead space ratio throughout the initiation to discontinuation phases of nitric oxide therapy. Trends in dead space ratio may aid in determining true need for nitric oxide and facilitate effective weaning. Further studies are needed to directly compare trends between success and failure groups.

Use of Nitric Oxide Inhalation for the Treatment of Pulmonary Hypertensive Crisis Bridging to Living-donor Lobar Lung Transplantation

2007 ◽  
Vol 13 (6) ◽  
pp. S51
Author(s):  
Soichiro Fuke ◽  
Kengo Fukushima Kusano ◽  
Kenki Enko ◽  
Masato Murakami ◽  
Takefumi Oka ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Lung Transplantation ◽  
Living Donor ◽  
Hypertensive Crisis ◽  
Nitric Oxide Inhalation ◽  
Pulmonary Hypertensive Crisis

scholarly journals The Role of Awake Extracorporeal Membrane Oxygenation as Bridging Therapy for Lung Transplantation: A Retrospective Cohort Study

2020 ◽  
Author(s):  
NAM EUN KIM ◽  
Song Yee Kim ◽  
Ah Young Leem ◽  
Youngmok Park ◽  
Se Hyun Kwak ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Lung Transplantation ◽  
Predictive Factor ◽  
Apache Ii Score ◽  
Independent Predictive Factor ◽  
Membrane Oxygenation ◽  
Operative Outcomes ◽  
Rescue Treatment ◽  
Risk Patients ◽  
End Stage

Abstract Background As lung transplantation (LTx) becomes a standard treatment for end-stage lung disease, bridging to LTx with extracorporeal membrane oxygenation (ECMO) is increasing during waiting time, for either rescue treatment or improving ability to rehabilitation before transplant. This study investigated post-operative outcomes in patients bridging to lung transplantation with ECMO, especially those receiving awake ECMO. Methods In this single-center study, we retrospectively reviewed 241 consecutive LTx patients between October 2012 and March 2019. Among them, 65 patients received ECMO support while waiting for LTx; these patients were analyzed according to their awakeness. Multivaribale logistic regression and Cox proportional hazard models were used to analyze variables associated awake strategy and mortality. Results Thirty-three patients (50.7%) were awake during bridging ECMO, and 32 patients (49.2%) were in sedative status. The median age of awake ECMO patients was 59.0 (IQR 54.0-63.0) years, and 63.1% of population was male. There were no significant differences between awake and non-awake ECMO patients with respect to age, comorbidities, APACHE II score, ECMO duration and ECMO blood flow. Awake group have better post-operative outcome in terms of statically shorter post-operative intensive care unit (ICU) length of stay (LOS) (awake vs. non-awake, 6 [4-9.5] vs. 16 [6-22], p = 0.004) and longer ventilator free days (VFDs) (awake vs. non-awake, 24 [11.0-25.0] vs. 0 [0.0-14.5], p = 0.001). Furthermore, the awake ECMO group had a significantly lower six-month mortality rate compared to the non-awake group (18.2% vs. 40.6%, p = 0.045). It was independent predictive factor for ability to gait after LTx ([OR] 4.128, 95% CI 1.094-15.572, p = 0.036). Conclusions Awake ECMO therapy could be useful for high-risk patients waiting for LTx, and might help shorten ICU LOS and improve survival benefit after LTx. Furthermore, awake ECMO was independent predictive factor for postoperative gaiting.

scholarly journals Lung Transplantation for Late-Onset Pulmonary Hypertension in a Patient with Congenital Diaphragmatic Hernia

2018 ◽  
Vol 06 (01) ◽  
pp. e100-e103
Author(s):  
Chiara Iacusso ◽  
Francesco Morini ◽  
Irma Capolupo ◽  
Andrea Dotta ◽  
Stefania Sgrò ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Respiratory Failure ◽  
Lung Transplantation ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Late Onset ◽  
Severe Malnutrition ◽  
Lung Hypoplasia ◽  
Tract Infections ◽  
End Stage

AbstractLung hypoplasia and pulmonary hypertension (PH) in association with congenital diaphragmatic hernia (CDH) may cause fatal respiratory failure. Lung transplantation (Ltx) may represent an option for CDH-related end-stage pulmonary failure. The aim of this study is to report a patient with CDH who underwent Ltx or combined heart-lung transplantation (H-Ltx). Our patient was born at 33 weeks of gestation, with a prenatally diagnosed isolated left CDH. Twenty-four hours after birth, she underwent surgical repair of a type D defect (according to the CDH Study Group staging system). Postoperative course was unexpectedly uneventful, and she was discharged home at 58 days of life. Echocardiography before discharge was unremarkable. Periodic follow-up revealed gastroesophageal reflux (GER) and initial scoliosis. At the age of 10, she was readmitted for severe PH. Lung function progressively deteriorated, and at the age of 14, she underwent H-Ltx due to end-stage respiratory failure. After discharge, she developed recurrent respiratory tract infections, severe malnutrition, and drug-induced diabetes. Scoliosis and GER progressed, requiring posterior vertebral arthrodesis and antireflux surgery, respectively. Bronchiolitis obliterans further impaired her respiratory function, and though she had a second Ltx, she died at the age of 18, 4 and 1.5 years after the first and the second Ltx, respectively. Late-onset PH is an ominous complication of CDH. From our patient and the six further cases collected from the literature, Ltx may be considered as a last-resource treatment in CDH patients with irreversible and fatal respiratory failure, although its prognosis seems unfair.

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