RESUMEN
BACKGROUND: Tracheal diverticulum (TD) is a rare entity in clinical practice, accidentally found by imaging methods. It is a potential factor for the development of chronic respiratory infections, contributing to the progression of preexisting lung diseases and putting the success of lung transplantation at risk. OBJECTIVES: This paper reports 2 cases of TD with atypical clinical presentation in post-lung transplant patients with recurrent infections and aims to present the importance of this differential diagnosis. DISCUSSION: Case 1: A 30-year-old man with terminal lung disease underwent bilateral lung transplantation with a satisfactory postoperative period. He presented with TD as a focus of recurrent infection associated with persistent hemoptysis. Indicated for surgical resection (cervicotomy with resection of tracheal diverticulum), without complications. He evolved uneventfully in the postoperative period and was clinically stable at follow-up. Case 2: A 57-year-old woman with hypersensitivity pneumonia associated with secondary pulmonary arterial hypertension and bronchiectasis underwent bilateral lung transplantation without complications. She presented with TD as a focus of infection associated with esophageal symptoms. Indicated for the surgical approach (cervicotomy with resection of tracheal diverticulum), she was asymptomatic at follow-up. CONCLUSION: Conservative treatment is recommended in elderly and asymptomatic patients. Surgical resection is based on the recurrence of symptoms and failure of clinical therapy and is the preferred approach for reported cases.
Asunto(s)
Divertículo , Trasplante de Pulmón , Enfermedades de la Tráquea , Adulto , Anciano , Divertículo/complicaciones , Divertículo/cirugía , Femenino , Humanos , Trasplante de Pulmón/efectos adversos , Masculino , Persona de Mediana Edad , Reinfección , Tomografía Computarizada por Rayos X/efectos adversos , Enfermedades de la Tráquea/diagnóstico , Enfermedades de la Tráquea/etiología , Enfermedades de la Tráquea/cirugíaRESUMEN
Tracheal stenosis in children is a challenge for the healthcare team, since it is a rare disease. Patients usually have other clinical comorbidities, mainly previous cardiac surgical interventions. This retrospective single-center study included infants with tracheal stenosis (congenital or acquired) operated between 2016 and 2020 on venoarterial extracorporeal membrane oxygenation (VA ECMO). Five patients were operated and the median age of detection of the tracheal disease was 3.7 months, and the median age at the operation was 5 months. All patients had associated cardiac anomalies. Four patients had congenital tracheal stenosis; two with associated pig bronchus. One patient had acquired subglottic stenosis with concomitant stenosis at the carina. After the operation, the patients were referred to ICU on ECMO with an open chest. Minor ECMO-related complications occurred in two patients (hemothorax and wound infection). All patients required endoscopic evaluation during the postoperative care; median of 3.2 procedures. Two patients are currently in follow-up and three have died. Slide tracheoplasty with VA-ECMO can be successfully performed in infants with prior cardiac surgery. Nevertheless, a difficult postoperative course should be anticipated, with possible prolonged ECMO use, readmissions, and higher morbidity and mortality than in children with tracheal stenosis alone.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Estenosis Traqueal/cirugía , Oxigenación por Membrana Extracorpórea/efectos adversos , Femenino , Cardiopatías Congénitas/complicaciones , Hemotórax/etiología , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Estenosis Traqueal/complicaciones , Estenosis Traqueal/mortalidad , Infección de Heridas/etiologíaRESUMEN
OBJECTIVE: To report initial experience from the use of extracorporeal membrane oxygenation (ECMO) in patients who received lung transplantation. METHODS: Retrospective study of a single tertiary center in the Brazilian state of São Paulo, a national reference in lung transplantation, based on the prospective collection of data from electronic medical records. The period analyzed extended from January 2009 (beginning of the program) until December 2018. RESULTS: A total of 75 lung transplants were performed, with ECMO used in 8 (10.7%) cases. Of the patients, 4 (50%) were female. The mean age was 46.4±14.3 years. The causes of the end-stage lung disease that led to transplantation were pulmonary arterial hypertension in 3 (37.5%) patients, bronchiectasis in 2 (25%) patients, pulmonary fibrosis in 2 (25%) patients, and pulmonary emphysema in 1 (12.5%) patient. In our series, 7 (87.5%) cases were sequential bilateral transplantations. Prioritization was necessary in 4 (50%) patients, and in 1 patient, ECMO was used as a bridge to transplantation. The ECMO route was central in 4 (50%), peripheral venovenous in 2 (25%) and peripheral venoarterial in 2 (25%) patients. The mean length of the intensive care unit (ICU) stay was 14±7.5 days and of the hospital stay was 34.1±34.2 days. The mean ECMO duration was 9.3±6.6 days with a 50% decannulation rate. Three patients were discharged (37.5%). CONCLUSION: Lung transplantation requires complex treatment, and ECMO has allowed extending the indications for transplantation and provided adjuvant support in the clinical management of these patients.
Asunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Enfermedades Pulmonares/terapia , Trasplante de Pulmón/métodos , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Bronquiectasia/epidemiología , Bronquiectasia/terapia , Femenino , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Prospectivos , Hipertensión Arterial Pulmonar/epidemiología , Hipertensión Arterial Pulmonar/terapia , Enfisema Pulmonar/epidemiología , Enfisema Pulmonar/terapia , Fibrosis Pulmonar/epidemiología , Fibrosis Pulmonar/terapia , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Fibrosis Quística , Infecciones por VIH , Trasplante de Pulmón , Adulto , Antiinfecciosos/uso terapéutico , Antirretrovirales/uso terapéutico , Brasil , Infecciones por Burkholderia/tratamiento farmacológico , Candidiasis/tratamiento farmacológico , Fibrosis Quística/complicaciones , Fibrosis Quística/cirugía , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Resultado del TratamientoAsunto(s)
Adulto , Femenino , Humanos , Infecciones por VIH , Trasplante de Pulmón , Fibrosis Quística , Brasil , Candidiasis/tratamiento farmacológico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Resultado del Tratamiento , Infecciones por Burkholderia/tratamiento farmacológico , Fibrosis Quística/cirugía , Fibrosis Quística/complicaciones , Antirretrovirales/uso terapéutico , Antiinfecciosos/uso terapéuticoRESUMEN
OBJECTIVE: To report initial experience from the use of extracorporeal membrane oxygenation (ECMO) in patients who received lung transplantation. METHODS: Retrospective study of a single tertiary center in the Brazilian state of São Paulo, a national reference in lung transplantation, based on the prospective collection of data from electronic medical records. The period analyzed extended from January 2009 (beginning of the program) until December 2018. RESULTS: A total of 75 lung transplants were performed, with ECMO used in 8 (10.7%) cases. Of the patients, 4 (50%) were female. The mean age was 46.4±14.3 years. The causes of the end-stage lung disease that led to transplantation were pulmonary arterial hypertension in 3 (37.5%) patients, bronchiectasis in 2 (25%) patients, pulmonary fibrosis in 2 (25%) patients, and pulmonary emphysema in 1 (12.5%) patient. In our series, 7 (87.5%) cases were sequential bilateral transplantations. Prioritization was necessary in 4 (50%) patients, and in 1 patient, ECMO was used as a bridge to transplantation. The ECMO route was central in 4 (50%), peripheral venovenous in 2 (25%) and peripheral venoarterial in 2 (25%) patients. The mean length of the intensive care unit (ICU) stay was 14±7.5 days and of the hospital stay was 34.1±34.2 days. The mean ECMO duration was 9.3±6.6 days with a 50% decannulation rate. Three patients were discharged (37.5%). CONCLUSION: Lung transplantation requires complex treatment, and ECMO has allowed extending the indications for transplantation and provided adjuvant support in the clinical management of these patients.