Acute Respiratory Distress Syndrome in a Lung Transplant Recipient Infected by a pUL97-Mutated Cytomegalovirus Associated with Decreased Phosphorylation of Ganciclovir

Respiration ◽  
2002 ◽  
Vol 69 (6) ◽  
pp. 564-568
Author(s):  
Rudolf Speich ◽  
Ariana Gaspert ◽  
Erich W. Russi ◽  
Walter Weder ◽  
Annette Boehler
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Transplant Recipient ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Lung Transplant ◽  
Distress Syndrome ◽  
Lung Transplant Recipient

scholarly journals First Wave of COVID-19 in French Patients with Cystic Fibrosis

2020 ◽  
Vol 9 (11) ◽  
pp. 3624 ◽  
Author(s):  
Harriet Corvol ◽  
Sandra de Miranda ◽  
Lydie Lemonnier ◽  
Astrid Kemgang ◽  
Martine Reynaud Gaubert ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Lung Transplant ◽  
Distress Syndrome ◽  
Rt Pcr ◽  
Respiratory Complications ◽  
Short Term ◽  
Transplant Patients

Viral infections are known to lead to serious respiratory complications in cystic fibrosis (CF) patients. Hypothesizing that CF patients were a population at high risk for severe respiratory complications from SARS-CoV-2 infection, we conducted a national study to describe the clinical expression of COVID-19 in French CF patients. This prospective observational study involves all 47 French CF centers caring for approximately 7500 CF patients. Between March 1st and June 30th 2020, 31 patients were diagnosed with COVID-19: 19 had positive SARS-CoV-2 RT-PCR in nasopharyngeal swabs; 1 had negative RT-PCR but typical COVID-19 signs on a CT scan; and 11 had positive SARS-CoV-2 serology. Fifteen were males, median (range) age was 31 (9–60) years, and 12 patients were living with a lung transplant. The majority of the patients had CF-related diabetes (n = 19, 61.3%), and a mild lung disease (n = 19, 65%, with percent-predicted forced expiratory volume in 1 s (ppFEV1) > 70). Three (10%) patients remained asymptomatic. For the 28 (90%) patients who displayed symptoms, most common symptoms at admission were fever (n = 22, 78.6%), fatigue (n = 14, 50%), and increased cough (n = 14, 50%). Nineteen were hospitalized (including 11 out of the 12 post-lung transplant patients), seven required oxygen therapy, and four (3 post-lung transplant patients) were admitted to an Intensive Care Unit (ICU). Ten developed complications (including acute respiratory distress syndrome in two post-lung transplant patients), but all recovered and were discharged home without noticeable short-term sequelae. Overall, French CF patients were rarely diagnosed with COVID-19. Further research should establish whether they were not infected or remained asymptomatic upon infection. In diagnosed cases, the short-term evolution was favorable with rare acute respiratory distress syndrome and no death. Post-lung transplant patients had more severe outcomes and should be monitored more closely.

Spontaneous Breathing during Extracorporeal Membrane Oxygenation in Acute Respiratory Failure

2017 ◽  
Vol 126 (4) ◽  
pp. 678-687 ◽  
Author(s):  
Stefania Crotti ◽  
Nicola Bottino ◽  
Giulia Maria Ruggeri ◽  
Elena Spinelli ◽  
Daniela Tubiolo ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Spontaneous Breathing ◽  
Lung Transplant ◽  
Gas Flow ◽  
Distress Syndrome ◽  
Membrane Oxygenation

Abstract Background We evaluate the clinical feasibility of spontaneous breathing on extracorporeal membrane oxygenation and the interactions between artificial and native lungs in patients bridged to lung transplant or with acute exacerbation of chronic obstructive pulmonary disease (COPD) or acute respiratory distress syndrome. Methods The clinical course of a total of 48 patients was analyzed. Twenty-three of 48 patients were enrolled in the prospective study (nine bridged to lung transplant, six COPD, and eight acute respiratory distress syndrome). The response to the carbon dioxide removal was evaluated in terms of respiratory rate and esophageal pressure swings by increasing (“relief” threshold) and decreasing (“distress” threshold) the extracorporeal membrane oxygenation gas flow, starting from baseline condition. Results Considering all 48 patients, spontaneous breathing extracorporeal membrane oxygenation was performed in 100% bridge to lung transplant (9 of 9 extubated), 86% COPD (5 of 6 extubated), but 27% acute respiratory distress syndrome patients (6 of 8 extubated; P < 0.001) and was maintained for 92, 69, and 38% of the extracorporeal membrane oxygenation days (P = 0.021), respectively. In all the 23 patients enrolled in the study, gas flow increase (from 2.3 ± 2.2 to 9.2 ± 3.2 l/min) determined a decrease of both respiratory rate (from 29 ± 6 to 8 ± 9 breaths/min) and esophageal pressure swings (from 20 ± 9 to 4 ± 4 cm H2O; P < 0.001 for all). All COPD and bridge to lung transplant patients were responders (reached the relief threshold), while 50% of acute respiratory distress syndrome patients were nonresponders. Conclusions Carbon dioxide removal through extracorporeal membrane oxygenation relieves work of breathing and permits extubation in many patients, mainly bridge to lung transplant and COPD. Only few patients with acute respiratory distress syndrome were able to perform the spontaneous breathing trial, and in about 50% of these, removal of large amount of patient’s carbon dioxide production was not sufficient to prevent potentially harmful spontaneous respiratory effort.

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