Extracorporeal membrane oxygenation and lung transplantation: initial experience at a single brazilian center

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.

Anemia falciforme e suas manifestações respiratórias / Pulmonary manifestations of sickle cell disease

A doença falciforme é a enfermidade monogênica mais comum no Brasil, sendo uma afecção sistêmica que potencialmente pode afetar vários órgãos e sistemas. O pulmão é um dos órgãos mais acometidos e as complicações na doença falciforme resultam em significante morbimortalidade na faixa pediátrica. Nesse contexto, o presente artigoapresenta as principais manifestações respiratórias da doença falciforme, em virtude da importância do diagnóstico precoce e da abordagem inicial por parte dos pediatras,especialmente da síndrome torácica aguda (STA), da hipertensão arterial pulmonar e da associação com a asma brônquica. O conhecimento por parte dos pediatras da abordagem adequada das manifestações respiratórias citadas no presente artigo de revisão é fundamental para o sucesso do tratamento, sendo também relevante o atendimento inicial adequado e o manejo do procedimento...

The Sickle Cell Disease is the most common inherited genetic disorder in Brazil being asystemic disease that can powerfully affect several organs and systems. The lungs are oneof the most affected and the consequences of the Sickle Cell Disease result in a significant morbid-mortality in pediatric patients and, in this context, the present article presents the main pulmonary manifestations of the stated disease. The article also considers the importance of an early diagnosis and the initial pediatric approach to these manifestations especiallyin: the Acute Chest Syndrome, Pulmonary Hypertension and the association of SickleCell Disease with Asthma. The acknowledgment by the Pediatricians of these respiratory manifestations is fundamental for the success of the treatment, and the initial assessment and adequate management of the procedure are also extremely relevant...