Update of early respiratory failure in the lung transplant recipient.
ABSTRACT Respiratory failure remains the most common complication in the perioperative period after lung transplantation. Consequently it is important to develop an approach to diagnosis and the treatment of respiratory failure in this population. This review highlights the advances made in the understanding and treatment of lung transplant patients in the early postoperative phase. Owing to its relative importance, advances in the understanding and treatment of ischaemia-reperfusion injury are highlighted.
The causes of respiratory failure and the complications seen after transplantation are time dependent, with ischaemia-reperfusion, infection, technical problems and acute rejection being the most common in the early perioperative phase, and obliterative bronchiolitis, rejection, and infections secondary to bacteria, fungi, and viruses becoming more prevalent after 3 months. The advances in lung preservation and postoperative care may be overshadowed by an increase in the complexity of the recipients and the use of more marginal organs. An improved mechanistic understanding of ischaemia-reperfusion injury has translated into potential therapeutic targets. The development of prospective clinical trials, however, is hampered by a relatively small sample of patients and a significant degree of heterogeneity in the lung transplant population.
Many advances have been made in the understanding of ischaemia-reperfusion injury. Owing to the acute and long-term implications of this complication, interventions that reduce the risk of developing ischaemia-reperfusion need to be evaluated in prospective clinical trials.
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ABSTRACT: Lung transplantation provides the prospect of improved survival and quality of life for patients with end stage lung and pulmonary vascular diseases. Given the severity of illness of such patients at the time of surgery, lung transplant recipients require particular attention in the immediate post-operative period to ensure optimal short-term and long-term outcomes. The management of such patients involves active involvement of a multidisciplinary team versed in common post-operative complications. This review provides an overview of such complications as they pertain to the practitioners caring for post-operative lung transplant recipients. Causes and treatment of conditions affecting early morbidity and mortality in lung transplant recipients will be detailed, including primary graft dysfunction, cardiovascular and surgical complications, and immunologic and infectious issues. Additionally, lung donor management issues and bridging the critically ill potential lung transplant recipient to transplantation will be discussed.09/2012; 1(3). DOI:10.1007/s13665-012-0018-9
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ABSTRACT: Patients with significant coronary artery disease were once traditionally rejected as candidates for lung transplants because of higher risk of morbidity and mortality. We report the case of a man who received a left lung transplant and coronary revascularization without extracorporeal circulation in a combined surgical procedure after being diagnosed with significant coronary disease during the preoperative study for acceptance as a candidate for lung transplantation. We review the history of such combination procedures, which are changing clinicians' attitudes as to appropriate therapeutic approaches to take for complex patients. We also discuss the possible advantages of performing surgery without extracorporeal circulation. To our knowledge, this is the first report of a combined procedure that took place in a Spanish hospital.Revista espanola de anestesiologia y reanimacion 57(7):425-30.
Conference Paper: Design and realization of DSC equipment[Show abstract] [Hide abstract]
ABSTRACT: In domestic communication networks, there exist analog and digital telecommunication systems at the same time. Signalling transformation equipment is needed for the interface of these two kind of systems. Digital line signalling conversion equipment (DSC) is used for the transformation between digital 2600 Hz line signalling carried by voice channels and digital type ABCD line signalling carried by TS16 in PCM. That is, the digitalized single frequency 2600 Hz line signalling carried by voice channels is on one side of the 2048 kbits/s digital trunk, and digital type ABCD line signalling carried by timeslot 16 is on the other side of the PCM trunk interface. The DSC interface equipment transforms the two sides associated signalling. DSC equipment may be built independently for PCM terminal equipment or TDM/FDM 60 channels TMUX, and installed in SPC rooms or other suitable places. It may be put together with PCM terminal equipment or TDM/FDM 60 channels TMUX. The DSC equipment consists of the following parts: digital trunk interface, filter and detector for signalling, microprocessor, alarm and display. The block diagram of the DSC equipment is shown. The authors adopt a series of MITEL chips to realize the trunk interface, system control and digital switchTENCON '93. Proceedings. Computer, Communication, Control and Power Engineering.1993 IEEE Region 10 Conference on; 11/1993