Early development of metabolic syndrome in patients subjected to lung transplantation.

Cardiovascular disease is a common cause of morbidity and mortality after solid organ transplantation, due to a combination of pre-existing cardiovascular risk factors and immunosuppressive drug toxicity. The prevalence of new-onset hypertension, dyslipidemia, diabetes mellitus, and metabolic syndrome was assessed after lung transplantation in a cohort of 67 patients (mean age: 48 ± 14 yr). The prevalence of hypertension increased from 19.4% to 70.1% at the three-yr follow-up visit (p < 0.01). The concomitant prevalence of diabetes and dyslipidemia raised from 13.4% to 31.3%, and from 6.0% to 40.3%, respectively (p < 0.01 for both), and body mass index increased from 22.4 ± 3.7 to 26.1 ± 3.9 kg/m(2) (p < 0.01). The prevalence of metabolic syndrome increased from 3.0% to 23.9% after the first year, to remain stable thereafter, associated with a strict control of cardiovascular risk factors. A large number of lung transplant recipients develop new-onset hypertension, diabetes, dyslipidemia after transplantation, and in more than one-fifth metabolic syndrome can be diagnosed after the first year. The increased cardiovascular risk of these patients should be taken into account during follow-up, to better define a proper and timely cardiovascular prevention. Adequate control of cardiovascular risk factors, preventing further metabolic syndrome development, is recommended and feasible in lung transplant recipients.

The effect of continuous positive airway pressure on pulmonary function may depend on the basal level of forced expiratory volume in 1 second.

BACKGROUND: The coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), also referred to as overlap syndrome (OS), is associated with a high rate of morbidity, COPD exacerbations and mortality. Treatment with continuous positive airway pressure (CPAP) has proven to significantly decrease the rate of these complications. However, data concerning the effect of CPAP on pulmonary function are scarce and conflicting. The aim of our study was to evaluate the effect of 1 year of CPAP treatment on arterial blood gases (ABGs) and pulmonary function tests in patients with OS and its potential relationship with the baseline severity of airway obstruction. A secondary aim was to search for predictors of changes in the evaluated parameters. METHODS: A retrospective study on a cohort of 92 patients (74 males) discharged from the Pulmonary Rehabilitation Unit of the Istituti Clinici Scientifici Maugeri in Pavia (Italy) from January 2013 to January 2016, with a diagnosis of OS and a prescription of CPAP, was conducted. Collected data at discharge were compared with 1-year follow-up data. RESULTS: After 1 year of CPAP, we observed the following: (I) a significant improvement in ABGs in all patients [median pO2 65.0 (59.0-70.0) vs. 71 (64.8-77.1) mmHg, pCO2 39.8 (36.2-43.5) vs. 38.3 (32.3-44.2) at baseline and after 1 year respectively, P<0.001], which was more pronounced in patients who were hypercapnic at baseline; (II) no significant change in respiratory function in the whole population; (III) a significant change in forced expiratory volume in 1 second (FEV1) only under and above a threshold of 79.1% of basal FEV1 with an opposite trend. In particular, patients with a basal FEV1 below that threshold significantly improved [median FEV1 70 (-70 to 200) mL, P=0.001], whereas patients with a basal FEV1 above the same threshold significantly worsened [median FEV1 -270 (-370 to -130) mL, P=3.05×10-5]. CONCLUSIONS: A population of overlap patients treated with CPAP may experience a different change in airflow obstruction after 1 year depending on the severity of baseline obstruction.

Decision-making for tracheostomy in amyotrophic lateral sclerosis (ALS): a retrospective study.

BACKGROUND: ALS patients should discuss the issue of tracheostomy before the onset of terminal respiratory failure. While the process of shared decision-making is desirable, there are few data on the practical application of this real-life situation. AIM OF THE STUDY: To determine how a decision-making process is actually carried out, we analysed the episodes of acute respiratory failure preceding tracheostomy. METHODS: We studied the charts of a group of ALS patients after tracheostomy. An interview focusing on the existence of anticipated directives was carried out. Tracheostomies were classified as planned or unplanned according to the presence of a decision plan. RESULTS: A total of 209 ALS patients were cared for during a three-year period. Of these patients, 34 (16%) were tracheotomised. In 38% of cases, tracheostomy was planned, 41% were unplanned, and 21% remained undiagnosed. CONCLUSIONS: A minority of ALS patients make a voluntary decision for tracheostomy before the procedure is conducted. The advising process of care still presents limits that have been thus far poorly addressed. In the future, we will need to develop guidelines for the timing and content of the shared-decision making process.