ABSTRACT
Despite advances in targeted medical therapy, pulmonary arterial hypertension (PAH) remains a fatal disease because of progressive right ventricular dysfunction. For patients who are refractory to medical therapy, heart-lung and lung transplantation are important treatment options. Because of longer waiting time, surgical interventions including extracorporeal lung support and atrial septostomy can be used in PAH patients bridging to transplantation.
Subject(s)
Hypertension, Pulmonary/surgery , Lung Transplantation/methods , Extracorporeal Membrane Oxygenation/methods , Heart Transplantation/methods , Humans , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/mortality , Survival RateABSTRACT
Diffuse pulmonary lung disease and chronic obstructive pulmonary disease is a heterogeneous population that can manifest pulmonary hypertension. These subgroups are classified as primarily World Health Organization group 3. Available data suggest that the impact of pulmonary hypertension targeted therapy in diffuse pulmonary lung disease and chronic obstructive pulmonary disease is limited and survival is poor despite attempted treatment.
Subject(s)
Hypertension, Pulmonary/etiology , Lung Diseases, Interstitial/complications , Pulmonary Disease, Chronic Obstructive/complications , Ventricular Function, Right/physiology , Heart Ventricles/physiopathology , Humans , Hypertension, Pulmonary/therapy , Lung Diseases, Interstitial/therapy , Pulmonary Disease, Chronic Obstructive/therapy , Ventricular Dysfunction, Right/etiologyABSTRACT
CASE PRESENTATION: A 75-year-old man was referred to our institution for worsening dyspnea, decreased activity tolerance, myalgias, and an increase in oxygen requirement. Nine months before the initial referral, the patient presented to an outside hospital for acute hypoxemic respiratory failure requiring a right-sided video-assisted thoracoscopic surgery (VATS) lung biopsy that disclosed organizing pneumonia (OP). He was treated with a prolonged steroid course starting at 1 mg/kg daily and tapered over 6 months to a baseline of 20 mg of prednisone daily and continuous oxygen (2 L/min). Prior attempts to further reduce prednisone resulted in worsening dyspnea, fevers, and myalgias. Despite optimal medical treatment for 3 months, he presented to our institution with progressive dyspnea, an increased oxygen requirement to 6 L/min, fatigue, and muscle weakness.
Subject(s)
Cryptogenic Organizing Pneumonia , Dyspnea , Myositis/diagnosis , Aged , Biomarkers/blood , Diagnosis, Differential , Drug Therapy, Combination , Humans , Male , Myositis/drug therapy , Respiratory Function TestsABSTRACT
STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Epidemiologic studies suggest that the prevalence of moderate to severe obstructive sleep apnea (OSA) is increasing. OSA has been linked to increased rates of postoperative complications following surgery. Large studies, however, regarding surgical outcomes in this patient population, particularly in the spine literature, are limited. Consequently, the purpose of this study was to assess the prevalence of and postoperative risks conferred by OSA in the elective spine population. METHODS: Using data from the National Inpatient Sample from 2008 to 2012, an estimated 56 372 (5.1%) patients with OSA undergoing elective cervical and thoracolumbar spine surgery were selected and compared to 1 052 837 patients without OSA undergoing the same procedures. Our primary outcome measures included postoperative complication rates, inpatient mortality, length of stay, and total hospital charges. RESULTS: Patients with OSA were, on average 2.6 years older than those without OSA (P < .001) and had a higher comorbidity burden. The prevalence of OSA increased between 2008 and 2012 from 3.5% to 6.8%; P < .001. OSA was associated with a 3-fold increase in major complications (P < .001) and was confirmed as an independent risk factor for major complications based on multivariate analysis (odds ratio [OR] = 2.82; 95% CI = 2.59-2.79; P < .001). Rates of deep venous thrombosis were doubled in patients with OSA. OSA was determined to be an independent predictor of pulmonary complications (OR = 2.69; 95% CI = 2.59-2.79; P < .001). OSA did not increase the risk of postoperative mortality. CONCLUSIONS: Patients with OSA often have multiple concomitant comorbidities and consequently are at increased risk of experiencing a more difficult postoperative course following elective spine surgery. Specifically, increased risks of pulmonary complications and deep venous thrombosis should be anticipated.