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Lung transplants for children: Exploring the intricacies

Most adult transplant centers require patients to walk a set distance in under six minutes to remain a good candidate for lung transplant. The thought is that if patients cannot meet this minimal threshold, then their chances of being able to rehabilitate after transplant are diminished. In pediatrics, this is also important. But Dawn Freiberger, RN, MSN, Boston Children’s Hospital’s Lung Transplant coordinator, says there are other factors that have to be considered. “The walk test is just one piece of the pie,” says Freiberger. In 2013, Freiberger co-authored a study, Pretransplant six-minute walk test predicts peri- and post-operative outcomes after pediatric lung transplantation, which became the precursor to a multicenter study with the Children’s Hospital of Philadelphia and St. Louis Children’s Hospital. The new study looks at how a child’s pre-transplant physical condition affects post-transplant outcomes. “A lot of centers believe if you are not physically fit you have a lesser chance of survival,” she says. “But children are different than adults; they can be physically fit in other ways. Kids exercise without realizing they are exercising.” Freiberger and co-investigator Anne Gould, PT, of the Division of Pulmonary and Respiratory Diseases at Boston Children’s, are following 40 patients until they are one-year post transplant. “We are studying pre-transplant variables...
Source: Mass Device - Category: Medical Equipment Authors: Tags: Blog Vector Blog Source Type: news

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Limited research has been produced to demonstrate the safety and efficacy of providing physical therapy interventions in advanced CHF (aCHF) patients on circulatory support. The efficacy of Phase 1 Cardiac Rehab is well studied post myocardial infarction and cardiac surgery. The purpose of this project was to assess the safety and efficacy of implementing Phase 1 cardiac rehabilitation in an in-patient gym setting; the population studied included individuals with aCHF awaiting further intervention, most receiving inotropic support and/or mechanical circulatory assistive devices.
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Source Type: research
Conclusions ECMO as BTT has led to encouraging perioperative outcomes and early survival. Careful patient selection and early utilization of ECMO seems to allow for preservation of vitality while these critically ill candidates await donor organs, which may improve outcomes.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
CONCLUSIONS: ECMO as BTT has led to encouraging perioperative outcomes and early survival. Careful patient selection and early utilization of ECMO seems to allow for preservation of vitality while these critically ill candidates await donor organs, which may improve outcomes. PMID: 29559375 [PubMed - as supplied by publisher]
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Ann Thorac Surg Source Type: research
Extracorporeal membrane oxygenation (ECMO) is a versatile mechanical circulatory support technique that may be used as salvage therapy for patients with refractory cardiorespiratory failure in the acute setting, or as a bridge to definitive management in the extended term. Ambulatory venovenous ECMO may help optimize the condition of patients with respiratory failure for lung transplantation by allowing physical therapy and preventing deconditioning.1 Experience with ambulatory venoarterial ECMO (VA-ECMO) as a bridging strategy for heart transplantation, however, is less common.
Source: The Journal of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Case report Source Type: research
I’ve had asthma and chronic lung disease since I was very young. I had to use everything — from my head to my toes — to help me breathe. I remember being able to hear myself wheezing, to feel my lungs rattling. I had marks all over my face from my oxygen mask. I thought I would never be clear of mucus and never be able to walk without being out of breath. All I ever wanted was to breathe. I spent so much energy trying to breathe that I didn’t have much left for eating, so I was really skinny. I spent a lot of time in a wheelchair. When I was able to walk, it would be for short distances and my shoul...
Source: Thrive, Children's Hospital Boston - Category: Pediatrics Authors: Tags: Diseases & Conditions Our Patients’ Stories chronic lung disease double lung transplant Francis Fynn-Thompson Gary Visner Lung Transplant Program Pediatric Transplant Center (PTC) Source Type: news
Discussion of advocacy for the cause is a usual feature of our community, as we try things and attempt to make progress in persuading the world that rejuvenation research is plausible, practical, and necessary. There are more people engaged in advocacy now than at any time in the past decade, and so discussions of strategy come up often. New ventures kicked off in 2017 include the Geroscience online magazine, and among the existing ventures the LEAF / Lifespan.io volunteers seem to be hitting their stride. The mainstream media continues to be as much a hindrance as a help, and where it is a help you will usually find Aubre...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
Venovenous extracorporeal membrane oxygenation (ECMO) has become a viable and increasingly utilized option for the treatment of refractory hypoxemia in severe acute respiratory distress syndrome (ARDS). However, options are limited for ARDS patients who fail to wean from ECMO. The high rates of infection, presence of extrapulmonary end organ damage, intensive care unit-acquired weakness, and high short-term mortality associated with ARDS are all significant hurdles that make lung transplantation a difficult prospect to consider. However, ECMO support has been used as a bridge to transplant in patients with other underlying...
Source: ASAIO Journal - Category: Medical Devices Tags: Case Reports Source Type: research
Conclusion Allowing patients to wake up by rapid weaning of continuous narcotics and anesthetic agents using Dexmedetomidine and periodic paralysis to favorably alter hemodynamics is a successful method to wean deep sedation in ECMO.
Source: Journal of Critical Care - Category: Gastroenterology Source Type: research
Conclusions This study demonstrated favorable survival in patients receiving ECMO as a bridge to lung transplantation and achieved high rates of physical therapy and avoidance of mechanical ventilation while ECMO was used in patients awaiting lung transplantation. With more than half of these patients successfully bridged to lung transplantation, we gained insight into the factors influencing patients’ outcomes, including patient selection, timing of ECMO, and patient management.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
Sedation in extracorporeal membrane oxygenation (ECMO) is challenging. Patients require deep sedation because of extremely high respiratory rates and increased work of breathing ( “Drowning Syndrome”) resulting in altered intra-thoracic pressure and reduced pump flow associated with hemodynamic compromise and decreased oxygenation. However, deep sedation impedes essential active rehabilitation with physical therapy.
Source: Journal of Critical Care - Category: Intensive Care Authors: Source Type: research
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