Heart & lung : the journal of critical care
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Multicenter Study
Mortality, rehospitalization, and post-transplant complications in gender-mismatched heart transplant recipients.
Limited research has been published on outcomes in heart transplant (HT) recipients with gender-mismatched donors. ⋯ Female HT recipients with male donors had worse 3-year outcomes as compared to male-mismatch and no-mismatch groups.
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Pulmonary arterial hypertension (PAH) is progressive disorder characterized by elevated pulmonary vascular resistance that can lead to right heart failure and death. One of the main therapeutic options for PAH are medications targeting the prostacyclin pathway. Treprostinil is a prostacyclin analogue and selexipag is a selective IP receptor agonist. ⋯ We present two patients with PAH who received medications targeting the prostacyclin pathway and were transitioned from inhaled treprostinil to either oral treprostinil or selexipag. In both cases, we noted clinical, functional and hemodynamic deterioration. These cases highlight that the route of delivery (inhaled versus oral) and/or the specific PH medication (treprostinil versus selexipag) matter; therefore close monitoring during transitions is imperative.
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Case Reports
The esophageal cooling device: A new temperature control tool in the intensivist's arsenal.
Therapeutic hypothermia has been demonstrated to improve neurological outcome in comatose survivors of cardiac arrest. Current temperature control modalities however, have several limitations. Exploring innovative methods of temperature management has become a necessity. ⋯ When used as a sole modality, objective performance parameters of the esophageal-cooling device were found to be comparable to standard temperature control methods. More research is required to further quantify efficacy, safety, assess utility in other patient populations, and examine patient outcomes with device use in comparison to standard temperature control modalities.
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Review Meta Analysis
The effect of N-acetylcysteine on exacerbations of chronic obstructive pulmonary disease: A meta-analysis and systematic review.
N-acetylcysteine (NAC) is an antioxidant and anti-inflammatory. Its effects on chronic obstructive pulmonary (COPD) outcomes, including exacerbation of and changes in lung function parameters, are controversial. To investigate the effects of NAC on COPD exacerbation and changes in lung function parameters in patients with COPD. ⋯ Long-term (≥6 months), but not short-term, NAC reduced exacerbation prevalence (RR = 0.85, 95% CI = 0.74-0.98, P = 0.024). NAC did not affect exacerbation rate, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), or inspiratory capacity (IC). Long-term NAC therapy may reduce risk of COPD exacerbation.
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To evaluate the development of an extracorporeal membrane oxygenation (ECMO) program for the treatment of acute respiratory distress syndrome (ARDS) in adults. ⋯ Our results endorse the use of ECMO as a rescue therapy in adults with ARDS, although there are some risks associated with a learning curve as well as an important increase in the days of patient stay. The justification for the maintenance of an ECMO program in adults should be based on future studies of efficacy and cost effectiveness.