Correlation between lung allocation score and early death risk of patients with idiopathic pulmonary fibrosis after lung transplantation / 器官移植

Objective To analyze the correlation between the lung allocation score (LAS) and the risk of early death and complications in patients with idiopathic pulmonary fibrosis (IPF) after lung transplantation. Methods Clinical data of 275 patients with IPF were retrospectively analyzed. The correlation between LAS and the risk of early death in IPF patients after lung transplantation and the correlation between LAS and complications at postoperative 1 year was assessed by univariate and multivariate Cox regression analyses. Results Among 275 recipients, 62, 83, 95 and 108 cases died within postoperative 30, 90, 180 and 365 d, respectively. LAS was correlated with 30-, 90-, 180- and 365-d fatality of IPF patients (all P<0.05), whereas it was not correlated with the incidence of primary graft dysfunction (PGD) and acute kidney injury (AKI) at 365 d after lung transplantation (both P>0.05). Conclusions LAS is correlated with the risk of early death of IPF patients after lung transplantation. While, it is not correlated the incidence of PGD and AKI early after lung transplantation. Special attention should be paid to the effect of comprehensive factors upon PGD and AKI.

Influencing factors of survival of patients with airway stenosis requiring clinical interventions after lung transplantation / 器官移植

Objective To analyze the influencing factors of survival of patients with airway stenosis requiring clinical interventions after lung transplantation. Methods Clinical data of 66 patients with airway stenosis requiring clinical interventions after lung transplantation were retrospectively analyzed. Univariate and multivariate Cox’s regression models were adopted to analyze the influencing factors of survival of all patients with airway stenosis and those with early airway stenosis. Kaplan-Meier method was used to calculate the overall survival and delineate the survival curve. Results For 66 patients with airway stenosis, the median airway stenosis-free time was 72 (52,102) d, 27% (18/66) for central airway stenosis and 73% (48/66) for distal airway stenosis. Postoperative mechanical ventilation time [hazard ratio (HR) 1.037, 95% confidence interval (CI) 1.005-1.070, P=0.024] and type of surgery (HR 0.400, 95%CI 0.177-0.903, P=0.027) were correlated with the survival of patients with airway stenosis after lung transplantation. The longer the postoperative mechanical ventilation time, the higher the risk of mortality of the recipients. The overall survival of airway stenosis recipients undergoing bilateral lung transplantation was better than that of their counterparts after single lung transplantation. Subgroup analysis showed that grade 3 primary graft dysfunction (PGD) (HR 4.577, 95%CI 1.439-14.555, P=0.010) and immunosuppressive drugs (HR 0.079, 95%CI 0.022-0.287, P<0.001) were associated with the survival of patients with early airway stenosis after lung transplantation. The overall survival of patients with early airway stenosis after lung transplantation without grade 3 PGD was better compared with that of those with grade 3 PGD. The overall survival of patients with early airway stenosis after lung transplantation treated with tacrolimus was superior to that of their counterparts treated with cyclosporine. Conclusions Long postoperative mechanical ventilation time, single lung transplantation, grade 3 PGD and use of cyclosporine may affect the survival of patients with airway stenosis after lung transplantation.

Pulmonary rehabilitation protocols in urgent lung transplantation patients / 世界急诊医学杂志（英文）

@#BACKGROUND: Prolonged invasive respiratory support and extracorporeal membrane oxygenation (ECMO) in patients requiring urgent lung transplantation (ULTx) present significant challenges to clinical practice due to severe underlying diseases and complex conditions. The aim of the study was to report the clinical outcomes of patients who received ULTx and followed the perioperative rehabilitation protocol implemented in a lung transplant center. METHODS: A retrospective analysis was conducted in ULTx patients who required preoperative invasive mechanical ventilation (IMV) and ECMO between January 2018 and January 2023. Data were retrieved from electronic medical records at our lung transplant center. RESULTS: Fourteen patients (mean age 57.43±10.97 years; 12 males, 2 females) underwent ULTx with bridging ECMO and IMV. The mean body mass index was 23.94±3.33 kg/m², and the mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 21.50±3.96. The Nutritional Risk Screening 2002 (NRS 2002) scores were ≥3. ULTx was performed after an 8.5-day waiting period (interquartile interval [IQR] 5.0-26.5 d). Following the surgeries, the average lengths of ECMO and IMV were 1.0 (IQR 1.0-2.0) d and 5.0 (IQR 3.0-7.3) d, respectively. The total length of hospital stay was 60.1±30.8 d, with an average intensive care unit stay of 38.3±22.9 d and post-operative hospitalization stay of 45.8±26.1 d. Two patients died within 30 d after ULTx, with a 30-day survival rate of 85.71%. CONCLUSION: Patients receiving ULTx showed an acceptable short-term survival rate, validating the practicality and safety of the treatment protocols implemented in our center.

Lung transplantation after paraquat poisoning in an adolescent: one case report and literature review / 器官移植

Objective To summarize the effect of the timing of lung transplantation and related treatment measures on clinical prognosis of patients with paraquat poisoning. Methods Clinical data of a patient with paraquat poisoning undergoing bilateral lung transplantation were retrospectively analyzed. Clinical manifestations, auxiliary examination, diagnosis and treatment of this patient were summarized and analyzed. Results A 17-year-old adolescent was admitted to hospital due to nausea, vomiting, cough and systemic fatigue after oral intake of 20-30 mL of 25% paraquat. After symptomatic support treatment, the oxygen saturation was not improved, and pulmonary fibrosis continued to progress. Therefore, sequential bilateral lung transplantation was performed under extracorporeal membrane oxygenation (ECMO). After postoperative rehabilitation and active prevention and treatment for postoperative complications, the patient was discharged at postoperative 50 d. Conclusions The timing of lung transplantation after paraquat poisoning may be selected when the liver and kidney function start to recover. Active and targeted prevention of potential pathogen infection in perioperative period and early rehabilitation training contribute to improving clinical prognosis of lung transplant recipients.

Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery

ABSTRACT Introduction: Extracorporeal membrane oxygenation (ECMO) is the first-line therapy for temporary mechanical circulatory support allowing cardiac and pulmonary recovery or as a bridge to further therapeutic alternatives. The aim of this study was to report clinical outcomes in adult patients with refractory cardiac failure after open-heart surgery undergoing ECMO in a single center with an ECMO unit in Chile. Methods: We retrospectively analyzed adults with refractory cardiac failure after open-heart surgery who required a venoarterial (VA) ECMO between 2016 and 2021. Results: Of 16 patients with VA ECMO, 60% were men (n=10), 90% had hypertension (n=14), 69% had < 30% of left ventricular ejection fraction (n=11), and the mean European System for Cardiac Operative Risk Evaluation II score was 12 ± 11%. ECMO support with central cannulation accounts for 81% (n=13), and an intra-aortic balloon pump was used in nine patients (56%). The mean time of support was 4.7 ± 2.6 days (1.5 - 12 days). ECMO weaning was achieved in 88% of patients, and in-hospital mortality was 44% (n=7) after discharge. The freedom from all-cause mortality at one year of follow-up of the entire cohort was 38% (n=6). Conclusion: VA ECMO is now a well-known life-saving therapeutic option, but mortality and morbidity remain high. Implementation of an ECMO program with educational training is mandatory in order to find the proper balance between patient benefits, ethical considerations, and public health financial input in South America.

Fulminant Necrotizing Eosinophilic Myocarditis Successfully Treated With Veno-Arterial Extracorporeal Membrane Oxygenation and High-Dose Steroids

Abstract Fulminant necrotizing eosinophilic myocarditis (FNEM) is a rare form of EM characterized by biventricular heart failure with hemodynamic deterioration, often requiring inotropes or mechanical circulatory support. Here, we report a case of a 43-year-old healthy woman with FNEM who was admitted with acute heart failure that rapidly progressed to cardiogenic shock and electrical storm, culminating in cardiac arrest. Early diagnosis and prompt administration of corticosteroids in combination with veno-arterial extracorporeal membrane oxygenation allowed complete recovery of biventricular systolic function.

Lactate and Lactate Clearance Are Predictive Factors for Mortality in Patients with Extracorporeal Membrane Oxygenation

ABSTRACT Introduction: Findings of inadequate tissue perfusion might be used to predict the risk of mortality. In this study, we evaluated the effects of lactate and lactate clearance on mortality of patients who had undergone extracorporeal membrane oxygenation (ECMO). Methods: Patients younger than 18 years old and who needed venoarterial ECMO support after surgery for congenital heart defects, from July 2010 to January 2019, were retrospectively analyzed. Patients successfully weaned from ECMO constituted Group 1, and patients who could not be weaned from ECMO were in Group 2. Postoperative clinics and follow-ups of the groups including mortality and discharge rates were evaluated. Results: There were 1,844 congenital heart surgeries during the study period, and 55 patients that required ECMO support were included in the study. There was no statistically significant difference between the groups regarding demographics and operative variables. The sixth-, 12th-, and 24th-hour lactate levels in Group 1 were statistically significantly lower than those in Group 2 (P=0.046, P=0.024, and P<0.001, respectively). There were statistically significant differences regarding lactate clearance between the groups at the 24th hour (P=0.009). The cutoff point for lactate level was found as ≥ 2.9, with 74.07% sensitivity and 78.57% specificity (P<0.001). The cutoff point for lactate clearance was determined as 69.44%, with 59.26% sensitivity and 78.57% specificity (P=0.003). Conclusion: Prognostic predictive factors are important to initiate advanced treatment modalities in patients with ECMO support. In this condition, lactate and lactate clearance might be used as a predictive marker.

Ações de cuidado e diagnósticos de enfermagem ao paciente com oxigenação por membrana extracorpórea: translação do conhecimento / Acciones de cuidado y diagnósticos de enfermería para pacientes con oxigenación por membrana extracorpórea: traslación del conocimiento / Care actions and nursing diagnoses for patients with extracorporeal membrane oxygenation: knowledge translation

Resumo Objetivo mapear diagnósticos e ações de enfermagem para o cuidado ao paciente adulto com oxigenação por membrana extracorpórea, considerando um protocolo e um sistema informatizado de prescrição e a inclusão de novas ações de cuidados, em um processo de translação do conhecimento à prática clínica. Métodos estudo descritivo e exploratório, com mapeamento cruzado entre um protocolo assistencial e sistema informatizado de um hospital universitário, no período de 2014 a 2018. Foram realizados dois encontros com a chefia de enfermagem e membros do time de oxigenação por membrana extracorpórea para validar as ações. Resultados diagnósticos mais comuns utilizados nos 45 prontuários dos pacientes com oxigenação por membrana extracorpórea foram: Risco de infecção (100%); Ventilação espontânea prejudicada (93,33%); Síndrome do déficit de autocuidado (93,33%). Conclusão e implicações para a prática o mapeamento incluiu 25 novas ações associadas a 14 diagnósticos de enfermagem no sistema informatizado, visando a disseminação do conhecimento e sua aplicação em cuidados reais a pacientes com oxigenação por membrana extracorpórea.

Resumen Objetivo mapear diagnósticos y acciones de enfermería para el cuidado de pacientes adultos con oxigenación por membrana extracorpórea, considerando un protocolo y un sistema de prescripción computarizado y la inclusión de nuevas acciones de cuidado, en un proceso de traslación del conocimiento a la práctica clínica. Métodos estudio descriptivo, exploratorio, con mapeo cruzado entre un protocolo de atención y un sistema informatizado en un hospital universitario, de 2014 a 2018. Posteriormente se realizaron dos reuniones con la gerente de enfermería y miembros del equipo de oxigenación por membrana extracorpórea para validar acciones. Resultados los diagnósticos más frecuentes utilizados en los 45 prontuarios de pacientes con oxigenación por membrana extracorpórea fueron: Riesgo de infección (100%); Deterioro de la ventilación espontánea (93,33%); Síndrome de déficit de autocuidado (93,33%). Conclusión e implicaciones para la práctica el mapeo incluyó 25 nuevas acciones asociadas a 14 diagnósticos de enfermería en el sistema informatizado, con el objetivo de difundir el conocimiento y su aplicación en la atención real al paciente con oxigenación por membrana extracorpórea.

Abstract Objective to map diagnoses and nursing actions for the care of adult patients with extracorporeal oxygenation membrane, considering a protocol and a computerized prescription system and the inclusion of new care actions, in a process of translating knowledge to clinical practice. Methods descriptive and exploratory study, with cross-mapping between a care protocol and a computerized system of at a university hospital, from 2014 to 2018. Two meetings were held with the nursing manager and members of the extracorporeal oxygenation membrane team to validate the actions. Results most common diagnoses used in the 45 medical records of patients with extracorporeal membrane oxygenation were: Risk of infection (100%); Impaired spontaneous ventilation (93.33%); Self-care deficit syndrome (93.33%). Conclusion and implications for practice The mapping included 25 new actions, associated with 14 nursing diagnoses in the computerized system, aiming to disseminate knowledge and its application in real care for patients with extracorporeal oxygenation membrane.

Métodos no invasivos de oxigenación en pacientes con COVID-19 / Non-invasive oxygenation methods in patients with COVID-19

Resumen: Desde el inicio de la pandemia por COVID-19, dentro de las complicaciones más frecuentes de esta infección se encuentran la neumonía y el síndrome de dificultad respiratoria aguda. La hipoxemia y el aumento del trabajo respiratorio son determinantes para adoptar diversas estrategias terapéuticas de oxigenación no invasiva en pacientes con COVID-19. Es importante conocer y describir las diferentes modalidades de oxigenoterapia no invasiva, con la finalidad de preservar la oxigenación y un adecuado trabajo respiratorio, las estrategias descritas en la literatura abarcan: cánulas nasales convencionales, cánulas nasales de alto flujo y ventilación mecánica no invasiva, aunado a otras medidas de soporte como posición prono, administración de esquemas con esteroide, inmunomoduladores y óxido nítrico inhalado. Las estrategias no invasivas de oxigenación por diferentes métodos son herramientas indispensables para el tratamiento de pacientes con neumonía por COVID-19 moderada-grave. Es necesario evaluar el dispositivo a emplear, ya que esta enfermedad tiene características heterogéneas de acuerdo con gravedad y el tiempo de evolución.

Abstract: Since the start of the COVID-19 pandemic, the most frequent complications of this infection include pneumonia and Acute Respiratory Distress Syndrome. Hypoxemia and increased work of breathing are determining factors in adopting various non-invasive oxygenation therapeutic strategies in patients with COVID-19. It is important to know and describe the different modalities of non-invasive oxygen therapy, in order to preserve oxygenation and adequate respiratory work, the strategies described in the literature include: conventional nasal cannulas, high-flow nasal cannulas and non-invasive mechanical ventilation coupled with other support measures such as prone position, administration of schemes with steroids, immunomodulators and inhaled nitric oxide. Non-invasive oxygenation strategies by different methods are essential tools for the treatment of patients with moderate-severe COVID-19 pneumonia. It is necessary to evaluate the device to be used, since this disease has heterogeneous characteristics according to severity and time of evolution.

Impacto del Entrenamiento Respiratorio de Hiperpnea Isocápnica Voluntaria sobre el Costo Energético asociado a la Respiración inducido por Ejercicio Físico / Impact of Voluntary Isocapnic Hyperpnea training on the cost of breathing

Introducción. Determinar el efecto de ocho semanas de entrenamiento por hiperpnea isocápnica voluntaria (HIV) sobre el costo energético asociado a la respiración (COB) reflejado en los cambios en la oxigenación de los músculos intercostales (∆SmO2-m. intercostales) inducida por ejercicio físico de intensidad incremental. Métodos. Doce participantes físicamente activos fueron entrenados durante ocho semanas de HIV 3 días x semana, 12 minutos, al 60% de ventilación voluntaria máxima (VVM). En la semana previa y posterior al entrenamiento HIV se realizó un test cardiopulmonar (CPET) de intensidad incremental en cicloergómetro, durante esta prueba se registró la ∆SmO2-m. intercostales mediante el dispositivo MOXY®. El efecto de HIV sobre la ∆SmO2-m. intercostales se analizó mediante la prueba two-way mixed ANOVA considerando los factores (fase × tarea). Resultados. ∆SmO2-m.intercostales fue significativamente menor a partir del 30% (­5,0±4,7%; p<0.01) hasta el 100% (­10,6±12,8%; p<0.01) de la tarea luego de ocho semanas de HIV. Además, se reportó un aumento de la presión inspiratoria máxima (PIM)=16,5±11,4 cmH2O (p<0.01); y de la resistencia muscular respiratoria=106,6±149,0 s (p<0.01). El tiempo total de ejercicio aumentó en 106,6±149,0 s (p=0.04), así como la carga total en 10,50± 10,12 vatios (p<0.01). Conclusión. El HIV disminuye el COB inducido por ejercicio incremental asociado a un incremento en la performance física y de los músculos respiratorios. En futuros estudios se sugiere estudiar esta estrategia de entrenamiento analítico de los músculos respiratorios en usuarios con limitación física relacionada al aumento prematuro del COB.

Background. Objetive. To determine the effect of eight weeks of voluntary isocapnic hyperpnea (VIH) training on cost of breathing (COB) as reflected by intercostales muscles deoxygenation (∆SmO2-m. intercostales) induced by incremental-intensity physical exercise. Methods. Twelve physically active participants underwent eight weeks of VIH training, three days a week, for 12 minutes each session, at 60% of maximal voluntary ventilation (MVV). In the week before and after VIH training, a cardiopulmonary test (CPET) of incremental intensity was performed on a cycloergometer. During this test, intercostal ∆SmO2-m.intercostales was recorded using the MOXY® device. The effect of VIH on ∆SmO2-m.intercostales were analyzed using a two-way mixed ANOVA test considering the factors (phase × task). Results. ∆SmO2-m.intercostales significantly decreased from 30% (­5.0±4.7%; p<0.01) to 100% (­10.6±12.8%; p<0.01) of the task after eight weeks of VIH. Additionally, an increase in maximal inspiratory pressure (MIP) of 16.5±11.4 cmH2O (p<0.01) and respiratory muscle endurance of 106.6±149.0 s (p<0.01) was reported. Total exercise time increased by 106.6±149.0 s (p=0.04), as well as total workload by 10.50±10.12 watts (p<0.01). Conclusion. VIH reduces COB induced by incremental exercise and is associated with increased physical and respiratory muscle performance. Future studies should explore this respiratory muscle training strategy for individuals with physical limitations related to a premature increase in COB.

Terapia medico nutricional en pacientes que reciben terapia de oxigenación por membrana extracorpórea: conocimiento en progreso / Medical nutrition therapy in patients receiving extracorporeal membrane oxygenation: knowledge in progress

Resumen El soporte nutricional (SN) en pacientes adultos que reciben terapia de oxigenación por membrana extracorpórea (ECMO, extracorporeal membrane oxygenation) es controvertido. Si bien existen guías para el SN en pacientes pediátricos con ECMO, en adultos no se cuenta con estos lineamientos para el uso, tipo, ruta y momento de la terapia nutricional. En pacientes críticamente enfermos es bien sabido que la nutrición enteral (NE) temprana es beneficiosa, no obstante existe la posibilidad de que en pacientes con ECMO la NE temprana condicione complicaciones gastrointestinales. Asimismo, no se han establecido metas calóricas, proteicas y dosis o tipos de micronutrimentos que usar para esta población en específico, siendo un reto para el clínico encargado de brindar el SN. Aunado a esto los pacientes con ECMO son algunos de los más gravemente enfermos en las unidades de cuidados intensivos, donde la desnutrición se asocia con una mayor morbilidad y mortalidad. En cuanto al uso de nutrición parenteral (NP), no se tiene descrito si implica riesgo de falla en el circuito al momento de introducir lípidos al oxigenador. Por lo anterior es imperativa una correcta evaluación e intervención nutricional específica, realizada por expertos en el tema para mejorar el pronóstico y la calidad de vida en esta población, siendo un objetivo primordial en los cuidados de los pacientes adultos que reciben terapia de ECMO.

Abstract Nutritional support in adult patients receiving extracorporeal membrane oxygenation (ECMO) therapy is controversial. Although there are guidelines for the NS (Nutritional support) in pediatric patients with ECMO, in adults these guidelines are not available for the use, type, route and timing of nutritional therapy. In critically ill patients it is well known that early enteral nutrition is beneficial, however there is the possibility that in patients with ECMO early enteral nutrition leads to gastrointestinal complications. Likewise, there have not been established caloric targets, proteins and doses or types of micronutrients to use for this specific population being a challenge for the clinician. In addition, patients with ECMO are some of the most seriously ill in intensive care units, where malnutrition is associated with increased morbidity and mortality. Regarding the use of parenteral nutrition (NP) it has not been described if it implies a risk of circuit failure at the time of introducing lipids to the oxygenator. Therefore, a correct evaluation and specific nutritional intervention by experts in the field is imperative to improve the prognosis and quality of life in this population, which is a primary goal in the care of adult patients receiving extracorporeal membrane oxygen.

Atención de enfermería en preescolar con atresia pulmonar en oxigenación con membrana extracorpórea: caso exitoso / Nursing Care in Kindergarten with Pulmonary Atresia in Extracorporeal Membrane Oxygenation: a Succesful Case / Cuidados de enfermagem em uma criança pré-escolar com atresia pulmonar em oxigenação por membrana extracorpórea: caso de sucesso

Introducción. La atresia pulmonar con comunicación interventricular es una cardiopatía compleja que enmarca grandes desafíos en su etapa pre y postquirúrgica; el uso del soporte vital extracorpóreo con membrana de oxigenación restablece la oxigenación y perfusión al organismo para permitir recuperación y complementar estudios. El objetivo de este caso clínico es determinar la atención de enfermería en la fase aguda post quirúrgica. Se expondrá usando el modelo teórico de Dorothea Orem: teorías de déficit de autocuidado y teoría de sistemas. Esta cardiopatía es la forma más severa de la tetralogía de Fallot. Tiene una incidencia del 2% entre todas las cardiopatías. Metodología. Es el caso de una preescolar con atresia pulmonar con comunicación interventricular, se describe los procesos realizados desde el diagnóstico, la intervención percutánea y reparo quirúrgico, así como el manejo de lesión residual en el marco del uso de diferentes tecnologías. Se resalta como elemento clave el uso del soporte con oxigenación con membrana extracorpórea usada como puente a decisión. Resultados. El plan de atención de enfermería en esta fase crítica logró los resultados planteados como la adecuada perfusión y oxigenación, recuperación de la función ventricular, estabilización hemodinámica para ser llevada al reparo de la lesión residual. Este novedoso soporte fue implementado dos veces durante la misma hospitalización y con resultados exitosos. Conclusiones. Caso de difícil manejo con terapias convencionales, pero con aplicación de una atención integral de enfermería; el uso de tecnología y de diversas especialidades permitió un egreso de la menor sin complicaciones. Palabras clave: Atresia Pulmonar; Oxigenación por membrana extracorpórea; Atención de Enfermería; Unidades de Cuidado Intensivo Pediátrico; Cardiopatías Congénitas.

Introduction. The pulmonary atresia with ventricular septal defect is a complex heart disseas that possess great challenges in pre and post-surgical stages; the use of vital support extracorporeal with membrane oxygenation restores oxygen and perfusion to the body to allow recovery and complement studies. The objetive of this case report is to determinate the nurse attention in the acute post quirulgical phase. It will be presented using Dorothea Orem's theoretical model: theories of self-care deficits and systems theory. This heart disease is the most severe form of tetralogy Fallot. It has an incidence of 2% among all heart diseases. Methodology. This is the case of a kindergarten with pulmonary atresia with ventricular septal defect, the processes carried out from diagnosis, percutaneous intervention and surgical repair are described, as well as the management of residual injury within the framework of the use of different technologies. The use of extracorporeal membrane oxygenation support used as a decision bridge is highlighted as a key element. Results. The nursing care plan in the critical phase achieved the results proposed as adequate perfusion and oxygenation, recovery of the ventricular function, hemodynamic stabilization to be carried out to repair the residual injury. This newfangled support was implemented twice during the same hospitalization with sucessful result. Conclusions. Case report with struggle managment with conventional therapies but with the application of comprehensive nursing care; the use of technology and the work of various specialities allowed the minor to be discharged without complications. Keywords: Pulmonary Atresia; Extracorporeal Membrane Oxygenation; Nursing Care; Intensive Care Units, Pediatric; Heart Defects, Congenital.

Introdução. A atresia pulmonar com comunicação interventricular é uma cardiopatia complexa que apresenta grandes desafios em sua fase pré e pós-cirúrgica. O uso de suporte de vida extracorpóreo com membrana de oxigenação restaura a oxigenação e a perfusão do corpo para permitir a recuperação e complementar os estudos. O objetivo deste caso clínico é determinar os cuidados de enfermagem na fase aguda pós-cirúrgica. Será apresentado utilizando o modelo teórico de Dorothea Orem: teorias do déficit de autocuidado e teoria de sistemas. Esta doença cardíaca é a forma mais grave de tetralogia de Fallot. Tem uma incidência de 2% entre todas as doenças cardíacas. Metodologia. É o caso de uma criança em idade pré-escolar com atresia pulmonar com comunicação interventricular, são descritos os processos realizados desde o diagnóstico, intervenção percutânea e reparação cirúrgica, bem como o manejo da lesão residual no âmbito da utilização de diferentes tecnologias. Destaca-se, como elemento-chave, a utilização de suporte com oxigenação por membrana extracorpórea como ponte para a decisão. Resultados. O plano de cuidados de enfermagem nesta fase crítica alcançou os resultados propostos como perfusão e oxigenação adequadas, recuperação da função ventricular, estabilização hemodinâmica a ser realizada para o reparo da lesão residual. Este novo suporte foi implementado duas vezes durante a mesma hospitalização e com resultados bem-sucedidos. Conclusões. Caso de difícil manejo com terapias convencionais, mas com aplicação de cuidados integrais de enfermagem, o uso da tecnologia e de diversas especialidades permitiu que a criança recebesse alta sem complicações. Palavras-chave: Atresia Pulmonar; Oxigenação por Membrana Extracorpórea; Cuidados de Enfermagem; Unidades de Terapia Intensiva Pediátrica; Cardiopatias Congênitas.

Use of Extracorporeal Membrane Oxygenation and Cerebral Oximetry in a Stage 1 Norwood Repair for Hypoplastic Left Heart Syndrome

The role of extracorporeal membrane oxygenation (ECMO) and its indications in stage I Norwood palliation are controversial. The decision to initiate ECMO and its timing remains difficult with no definitive cut?off points or evidence?based guidelines. It varies on a case?to?case basis. We report a case where the use of ECMO was beneficial after stage I Norwood palliation with severe ventricular dysfunction. The systemic?to?pulmonary artery shunt was kept open to balance the systemic and pulmonary circulations. Cerebral oximetry can be useful as an additional monitoring modality to guide management, monitor cerebral perfusion, and help detect cerebral steal.

Avaliação dos registros de enfermagem sobre oxigenação por membrana extracorpórea em equipe multidisciplinar treinada / Evaluation of nursing records on extracorporal membrane oxygenation after multidisciplinary training / Evaluación de registros de enfermería sobre oxigenación por membrana extracorpórea después de entrenamiento multidisciplinar

Objetivos: comparar o conteúdo dos registros de enfermagem referente à oxigenação por membrana extracorpórea (ECMO) entre os períodos de pré e pós-treinamento da equipe multidisciplinar. Método: estudo retrospectivo realizado em uma unidade de terapia intensiva adulto, com pacientes em uso de ECMO entre 2012 e 2019. Foram analisadas as informações das anotações, evoluções e prescrições de enfermagem sobre a ECMO. Resultados: foram incluídos 194 registros de enfermagem, que evidenciaram melhora na qualidade da evolução de enfermagem referente às informações da ECMO no período pós-treinamento. Dentre as informações, destaca-se a qualidade do registro sobre o circuito e a membrana. Conclusão: o treinamento multidisciplinar em ECMO foi fundamental para a melhoria das informações nas evoluções de enfermagem. Contudo, a continuidade de treinamentos se faz essencial para manutenção adequada dos registros de enfermagem que envolvem este suporte

Objectives: to compare nursing records regarding extracorporeal membrane oxygenation (ECMO) between pre- and post-multidisciplinary training. Method:A retrospective study was conducted in an Intensive Care Unit (ICU) with patients using ECMO, between 2012 and 2019. Notes, evolutions and nursing prescriptions on ECMO were analyzed. Results: the 194 nursing records analyzed revealed an improvement in the quality of nursing records regarding ECMO information post-training. Among the information, the quality of circuit and membrane records stands out. Conclusion: multidisciplinary training in ECMO was fundamental for improving information in nursing evolutions. However, continued training is essential for the proper maintenance of nursing records regarding this suppor

Objetivos: comparar el contenido de los registros de enfermería con respecto a la oxigenación por membrana extracorpórea (ECMO) entre los períodos pre y pos-entrenamiento del equipo multidisciplinario. Método: estudio retrospectivo, realizado en una unidad de cuidados intensivos (UCI), con pacientes en uso de ECMO entre 2012 y 2019. Se analizó información de notas, evoluciones y prescripciones de enfermería sobre ECMO. Resultados: se incluyeron 194 registros de enfermería, en los cuales se observó una mejora de la calidad en las evoluciones de enfermería respecto a la información de la ECMO en el período posterior al entrenamiento. Entre las informaciones destaca la calidad del registro en circuito y la membrana tras el entrenamiento. Conclusión: el entrenamiento multidisciplinar en ECMO fue fundamental para mejorar la información en los registros de enfermería. Sin embargo, la continuidad del entrenamiento es clave para el correcto mantenimiento de los registros de enfermería en relación con este apoyo

Advances in Extracorporeal Support Technologies in Critically Ill Children

The field of pediatric heart failure is evolving, and the patient population is growing as survival after complex congenital heart surgeries is improving. Mechanical circulatory support and extracorporeal respiratory support in critically ill children has progressed to a mainstay rescue modality in pediatric intensive care medicine. The need for mechanical circulatory support is growing, since the number of organ donors does not meet the necessity. This article aims to review the current state of available mechanical circulatory and respiratory support systems in acute care pediatrics, with an emphasis on the literature discussing the challenges associated with these complex support modalities

Correlación entre síndrome coronario agudo y COVID-19 en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández

Introducción: las infecciones agudas por SARS-CoV-2 (COVID-19) provocaron una pandemia global desde que aparecieran los primeros casos en Wuhan (China) en diciembre de 2019. Objetivo: determinar la correlación entre la infección por COVID-19 y algunas variables clínicas en la aparición del síndrome coronario agudo. Materiales y métodos: se realizó un estudio descriptivo retrospectivo en 85 pacientes que ingresaron en la Unidad de Cuidados Intensivos Emergentes del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, con diagnóstico de infección por COVID-19, en el período entre julio y septiembre de 2021. Durante su evolución clínica, 16 de ellos tuvieron un síndrome coronario agudo. Se aplicó el test chi cuadrado y significación estadística (p < 0,05). Resultados: el total de pacientes con síndrome coronario agudo durante la evolución de la infección por COVID-19, representó el 18,82 %. En este grupo predominaron personas de piel blanca y sexo femenino, para un 51,31 % (p < 0,02). El síndrome coronario agudo apareció después de 10 días de evolución de la infección por COVID-19, asociado a trastornos de la oxigenación. El 62,5 % de los pacientes fueron tratados con máscara con reservorio. La mayoría de los pacientes fue transferida viva a las unidades de cuidados progresivos. Conclusiones: se observó asociación estadística significativa entre féminas de raza blanca y la aparición del síndrome coronario agudo en el curso de la infección por COVID-19, en la Unidad de Cuidados Intensivos Emergentes del hospital matancero.

Introduction: acute infections by SARS-CoV-2 (COVID-19) caused a global pandemic since the first cases appeared in Wuhan (China) in December 2019. Objective: to determine the correlation between COVID-19 infection and some clinical variables at the onset of acute coronary syndrome. Materials and methods: a retrospective descriptive study was carried out in 85 patients who were admitted in the Emergent Intensive Care Unit of the Clinical Surgical University Hospital Comandante Faustino Perez Hernandez, with diagnosis of COVID-19 infection, in the period from July to September 2021. During their clinical evolution, 16 of them had acute coronary syndrome. The Chi-square test and statistical significance (p < 0.05) were applied. Results: the total of patients with acute coronary syndrome during the evolution of the COVID-19 infection represented 18.82%. White-skinned and female people predominated in this group, for 51.31% (p < 0.02). Acute coronary syndrome appeared after 10 days of the COVID-19 infection evolution, associated to oxygenation disorders. 62.5% of the patients were treated with reservoir masks. Most of the patients were transferred alive to progressive care units. Conclusions: a significant statistic association was observed between white women and the onset of acute coronary syndrome in the course of COVID-19 infection, in the Emergent Intensive Care Unit of Matanzas hospital.

Multiparameters Associated to Successful Weaning from VA ECMO in Adult Patients with Cardiogenic Shock or Cardiac Arrest: Systematic Review and Meta?Analysis

Venoarterial extracorporeal membrane oxygenation (VA ECMO) is a form of temporary mechanical circulatory support and simultaneous extracorporeal gas exchange for acute cardiorespiratory failure, including refractory cardiogenic shock (CS) and cardiac arrest (CA). Few studies have assessed predictors of successful weaning (SW) from VA ECMO. This systematic review and meta-analysis aimed to identify a multiparameter strategy associated with SW from VA ECMO. PubMed and the Cochrane Library and the International Clinical Trials Registry Platform were searched. Studies reporting adult patients with CS or CA treated with VA ECMO published from the year 2000 onwards were included. Primary outcomes were hemodynamic, laboratory, and echocardiography parameters associated with a VA ECMO SW. A total of 11 studies (n=653) were included in this review. Pooled VA ECMO SW was 45% (95%CI: 39�%, I2 7%) and in?hospital mortality rate was 46.6% (95%CI: 33�%; I2 36%). In the SW group, pulse pressure [MD 12.7 (95%CI: 7.3�) I2 = 0%] and mean blood pressure [MD 20.15 (95%CI: 13.8�.4 I2 = 0) were higher. They also had lower values of creatinine [MD �59 (95%CI: �9 to �2) I2 = 7%], lactate [MD �1 (95%CI: �4 to �7) I2 = 89%], and creatine kinase [�79.5 (95%CI: �87 to �1) I2 = 38%]. And higher left and right ventricular ejection fraction, MD 17.9% (95%CI: �2�.2) I2 = 91%, and MD 15.9% (95%CI 11.9�) I2 = 0%, respectively. Different hemodynamic, laboratory, and echocardiographic parameters were associated with successful device removal. This systematic review demonstrated the relationship of multiparametric assessment on VA ECMO SW.

The Use of Intraoperative Extracorporeal Membrane Oxygenation in Lung Transplantation: Initial Institutional Experience

ABSTRACT Introduction: Lung transplantation is the final treatment option for end-stage lung disease, and extracorporeal membrane oxygenation (ECMO) is increasingly being used during lung transplantation. Objective: The present study aimed to review our initial experience with patients who underwent lung transplantation with or without ECMO since the implementation of the lung transplantation program at our center. Methods: Data were prospectively collected on all patients between December 2016 and December 2018. Patients undergoing ECMO as a bridge to lung transplantation were excluded. Results: A total of 48 lung transplants were performed, and ECMO was used in 29 (60.4%) cases. Twenty (83%) patients were female. The median age was 48.5 (range, 14-64) years. The most common indications were idiopathic interstitial pneumonia in 9 (31%) patients, chronic obstructive pulmonary disease in 7 (24.1%) patients, and bronchiectasis in 6 (20.7%) patients. Sequential bilateral lung transplantation was performed in all patients. The 30-day mortality was 20.6% (6/29) for patients with ECMO, however, it was 10.5 (2/19) for patients without ECMO (P=0.433). The median length of stay in the intensive care unit (ICU) was 5 (range, 2-25) days. The ECMO weaning rate was 82.8% (24/29). One-year survival was 62.1% with ECMO versus 78.9% without ECMO, and the 3-year survival was 54.1% versus 65.8%, respectively (P=0.317). Conclusions: ECMO is indicated for more severe patients who underwent lung transplantation. The use of ECMO provides adjuvant support during surgery and the mortality rate is acceptable. Survival is also as similar as non-ECMO patients. ECMO is appropriate for critically ill patients.

Use of Impella Devices for Acute Cardiogenic Shock in the Perioperative Period of Cardiac Surgery

ABSTRACT Introduction: The Impella ventricular support system is a device that can be inserted percutaneously or directly across the aortic valve to unload the left ventricle. The purpose of this study is to determine the role of Impella devices in patients with acute cardiogenic shock in the perioperative period of cardiac surgery. Methods: A retrospective single-surgeon review of 11 consecutive patients who underwent placement of Impella devices in the perioperative period of cardiac surgery was performed. Patient records were evaluated for demographics, indications for placement, and postoperative outcomes. Results: Impella devices were placed for refractory cardiogenic shock preoperatively in 6 patients, intraoperatively in 4 patients, and postoperatively as a rescue in 1 patient. Seven patients received Impella CP, 1 Impella RP, 1 Impella CP and RP, and 2 Impella 5.0. Additionally, 3 patients required preoperative venovenous extracorporeal membrane oxygenation (VV-ECMO), and 1 patient required intraoperative venoarterial extracorporeal membrane oxygenation (VA-ECMO). All Impella devices were removed 1 to 28 days after implantation. Length of stay in the intensive care unit stay ranged from 2 to 53 days (average 23.9±14.6). The 30-day and 1-year mortality were 0%. Ten of 11 patients were alive at 2 years. Also, 1 patient died 18 months after surgery from complications of coronavirus disease (Covid-19). Device-related complications included varying degrees> of hemolysis in 8 patients (73%) and device malfunction in 1 patient (9%). Conclusions: The Impella ventricular support system can be combined with other mechanical support devices for additional hemodynamic support. All patients demonstrated myocardial recovery with no deaths in the perioperative period and in 1-year of follow-up. Larger studies are necessary to validate these findings.

Venoarterial Extracorporeal Membrane Oxygenation as A Bridge to Surgery in Post-Myocardial Infarction Ventricular Septal Defect with Cardiogenic Shock: Case Report

ABSTRACT We describe a 60-year-old woman with post-myocardial infarction (MI) ventricular septal defect (VSD) and cardiogenic shock who was successfully stabilized with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge therapy for the surgical closure of her VSD. This case highlights the role of VA-ECMO in the management of post-MI VSD to improve the results of surgical repair and patient survival.