Early postoperative management of lung transplantation.

Lung transplantation is a widely accepted therapeutic option for patients with end-stage lung disease. However, despite the significant medical progress achieved since the first human lung transplant was performed in 1963, perioperative and long-term patient outcomes are still jeopardised by a variety of complications. Infection and rejection are among the most feared complications in the early post-transplantation period because they are difficult to treat and can have a long-lasting impact on the quality of life and overall life expectancy. Multidisciplinary management of lung transplant recipients focusing on the prevention or early detection of complications, particularly during the early postoperative phase, may improve the short and long-term outcomes of those patients benefiting from this life-saving intervention. However, in the absence of internationally recognised guidelines, the optimal strategies for managing lung transplant recipients remain unclear. This article presents a practical approach to the management of the early post-transplantation period aiming at standardising clinical care and improving patient outcome.

Papel de los biomarcadores en el diagnóstico diferencial de la insuficiencia respiratoria aguda en el postoperatorio inmediato del trasplante pulmonar / Role of biomarkers in the differential diagnosis of acute respiratory failure in the immediate postoperative period of lung transplantation

Los receptores de un trasplante pulmonar tienen un alto riesgo de presentar numerosas complicaciones durante el postoperatorio inmediato, como la disfunción primaria del injerto, el rechazo agudo del injerto o las infecciones. El síntoma más común será la presencia de insuficiencia respiratoria aguda, y el uso de biomarcadores podría ser de gran utilidad para establecer un diagnóstico precoz de estas entidades. Hasta la fecha, se han estudiado diferentes biomarcadores, pero ninguno ha demostrado ser el gold estándar en el diagnóstico diferencial de la insuficiencia respiratoria aguda. En este artículo se expone una revisión de los diversos biomarcadores que han sido estudiados en este campo (AU)

Lung transplant recipients are at high risk of suffering many complications during the immediate postoperative period, such as primary graft dysfunction, acute graft rejection or infection. The most common symptom is the presence of acute respiratory failure, and the use of biomarkers could be useful for establishing an early diagnosis of these conditions. Different biomarkers have been studied, but none have proven to be the gold standard in the differential diagnosis of acute respiratory failure. This paper offers a review of the different biomarkers that have been studied in this field (AU)

[Role of biomarkers in the differential diagnosis of acute respiratory failure in the immediate postoperative period of lung transplantation]. / Papel de los biomarcadores en el diagnóstico diferencial de la insuficiencia respiratoria aguda en el postoperatorio inmediato del trasplante pulmonar.

Lung transplant recipients are at high risk of suffering many complications during the immediate postoperative period, such as primary graft dysfunction, acute graft rejection or infection. The most common symptom is the presence of acute respiratory failure, and the use of biomarkers could be useful for establishing an early diagnosis of these conditions. Different biomarkers have been studied, but none have proven to be the gold standard in the differential diagnosis of acute respiratory failure. This paper offers a review of the different biomarkers that have been studied in this field.

[Antifungal prophylaxis in the postoperative period of lung transplant surgery in Spain]. / Profilaxis antifúngica en el postoperatorio de trasplante de pulmón en España.

OBJECTIVES: To examine the type and duration of antifungal prophylaxis provided during the postoperative period of lung transplant recipients, together with the most frequent complications during admission to Intensive Care Units in Spain. PATIENTS AND METHODS: A questionnaire was developed including demographic data on each transplant center, the type of antifungal prophylaxis used, its duration, and the most frequent complications. The questionnaire was distributed among the 7 Spanish national lung transplant centers, followed by analysis of the results obtained. RESULTS: All 7 centers completed the questionnaire. All of them provided universal prophylaxis in lung transplant patients. Monotherapy was the most widely used protocol (5/7; 71.4%), with amphotericin B in liposomal or conventional form being the most frequent drug, administered via the inhalatory route. In the case of combination therapy, a great diversity of drugs was observed. The most frequently administered second choice drug was anidulafungin (3/7; 43%), followed by voriconazole (2/7; 28.5%). Antifungal therapy was maintained on an indefinite basis by 43% of the centers. Invasive fungal infection (IFI) in the postoperative period of transplantation during admission to the Intensive Care Unit was suspected in 5-10% of the cases but was confirmed in less than 5%. Among other complications registered in these patients in the Intensive Care Unit, the most frequent problems were respiratory infections (5/7; 71.5%). CONCLUSIONS: Antifungal prophylaxis during the postoperative period of lung transplantation is provided on a universal basis, though consensus is lacking as to the drug of choice, the administration route and the duration of such treatment.

[RS3PE associated with tuberculosis]. / RS3PE asociado a tuberculosis.

The remitting seronegative symmetrical synovitis with pitting edema of the elderly patient with edema and fovea (RS3PE), characterizes for the appearance of one polyarthritis symmetrical with fovea in the back of the hands, and negative reumatoideal factor. The association to tuberculosis had not been described before. One presents the case of a 89-year-old patient who consulted for anorexia of month and a half of evolution accompanied of edema in hands and feet, with negative reumatoideal factor. He was presenting a pulmonary infiltrated, which microbiological study revealed the infection for Mycobacterium tuberculosis.

Phase diagram of La(5/8-y)Nd(y)Ca(3/8)MnO(3) manganites.

We report a detailed study of the electric transport and magnetic properties of the La(5/8-y)Nd(y)Ca(3/8)MnO(3) manganite system. Substitution of La(3+) by smaller Nd(3+) ions reduces the mean ionic radius of the A-site ion. We have studied samples in the entire range between La-rich and Nd-rich compounds (0.1

[Cohort study on incidence of ARDS in patients admitted to the ICU and prognostic factors of mortality]. / Estudio de cohortes sobre incidencia de SDRA en pacientes ingresados en UCI y factores pronósticos de mortalidad.

OBJECTIVE: Analyze acute respiratory distress syndrome (ARDS) in patients admitted to an Intensive Care Medicine Service (ICMS) and prognostic factors of mortality in these patients. DESIGN: Prospective study of all the patients admitted consecutively in the ICMS from January 1998 to February 2003. SCOPE: ICMS of a third level university site with 32 beds in its General Area and 10 beds in the Traumatology Area. PATIENTS: Patients who met the ARDS criteria of the European-North American Consensus Conference at any time during admission in ICMS. ENDPOINTS OF INTEREST: Mortality at 28 days. RESULTS: One hundred and ninety-one patients (3.4 of all the admissions in ICMS) had ARDS criteria. The origin of ARDS was intrapulmonary in 63%. A total of 77% of the patients had multiorgan dysfunction and 26% respiratory superinfection. Median stay in the ICMS was 20 days. Mortality at 28 days was 48% and hospital mortality 58%. Multivariant analysis showed that the variables associated independently with an increase in mortality were the following: APACHE II > 22 (odds ratio [OR] 2.7; 95% CI: 1.3-5.8; p = 0.007), minimum PaO2/FIO2 during evolution of ARDS < 81 mmHg (odds ratio 5.5; 95% CI: 2.6-11.9; p < 0.0001), dysfunction > or = 3 organs (odds ratio 11.8; 95% CI: 2.5-55.4; p = 0.002). CONCLUSIONS: ARDS is an entity with elevated mortality whose prognosis is associated not only with the seriousness of pulmonary function deterioration but also of systemic function, on which some treatment could modulate its evolution.

Estudio de cohortes sobre incidencia de SDRA en pacientes ingresados en UCI y factores pronósticos de mortalidad / Cohort study on incidence of ARDS in patients admitted to the ICU and prognostic factors of mortality

Objetivo. Analizar la frecuencia del síndrome de distrés respiratorio agudo (SDRA) en pacientes ingresados en un Servicio de Medicina Intensiva (SMI) y los factores pronósticos de mortalidad en estos pacientes. Diseño. Estudio prospectivo de todos los pacientes ingresados de forma consecutiva en el SMI desde enero de 1998 a febrero de 2003. Ámbito. SMI de un centro universitario de tercer nivel con 32 camas en su Área General y 10 camas en el Área de Traumatología. Pacientes. Pacientes que cumplieron los criterios de SDRA de la Conferencia de Consenso Europeo-Norteamericana en cualquier momento durante el ingreso en el SMI. Variables de interés. Mortalidad a los 28 días. Resultados. Ciento noventa y un pacientes (3,4% del total de ingresos en el SMI) cumplieron criterios de SDRA. El origen del SDRA fue intrapulmonar en el 63%. Un 77% de los pacientes presentaron disfunción multiorgánica y un 26% sobreinfección respiratoria. La mediana de la estancia en el SMI fue de 20 días. La mortalidad a los 28 días fue del 48% y la mortalidad hospitalaria del 58%. El análisis multivariante mostró que las variables asociadas de manera independiente con un aumento de la mortalidad fueron las siguientes: APACHE II > 22 (odds ratio [OR] 2,7; IC 95%: 1,3-5,8; p = 0,007), PaO2/FIO2 mínima durante la evolución del SDRA < 81 mmHg (OR 5,5; IC 95%: 2,6-11,9; p < 0,0001), disfunción ≥ 3 órganos (OR 11,8; IC 95%: 2,5-55,4; p = 0,002). Conclusiones. El SDRA es una entidad de elevada mortalidad, cuyo pronóstico se asocia no sólo a la gravedad del deterioro de la función pulmonar, sino también sistémica, sobre la que algún tratamiento podría modular su evolución

Objective. Analyze acute respiratory distress syndrome (ARDS) in patients admitted to an Intensive Care Medicine Service (ICMS) and prognostic factors of mortality in these patients. Design. Prospective study of all the patients admitted consecutively in the ICMS from January 1998 to February 2003. Scope. ICMS of a third level university site with 32 beds in its General Area and 10 beds in the Traumatology Area. Patients. Patients who met the ARDS criteria of the European-North American Consensus Conference at any time during admission in ICMS. Endpoints of interest. Mortality at 28 days. Results. One hundred and ninety-one patients (3.4 of all the admissions in ICMS) had ARDS criteria. The origin of ARDS was intrapulmonary in 63%. A total of 77% of the patients had multiorgan dysfunction and 26% respiratory superinfection. Median stay in the ICMS was 20 days. Mortality at 28 days was 48% and hospital mortality 58%. Multivariant analysis showed that the variables associated independently with an increase in mortality were the following: APACHE II > 22 (odds ratio [OR] 2.7; 95% CI: 1.3-5.8; p = 0.007), minimum PaO2/FIO2 during evolution of ARDS < 81 mmHg (odds ratio 5.5; 95% CI: 2.6-11.9; p < 0.0001), dysfunction ≥ 3 organs (odds ratio 11.8; 95% CI: 2.5-55.4; p = 0.002). Conclusions: ARDS is an entity with elevated mortality whose prognosis is associated not only with the seriousness of pulmonary function deterioration but also of systemic function, on which some treatment could modulate its evolution