Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Anti-Hipertensivos/uso terapêutico , Embolia Pulmonar/cirurgia , Hipertensão Pulmonar/cirurgia , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/tratamento farmacológico , Endarterectomia , Doença Pulmonar Obstrutiva Crônica/terapia , Receptores de EndotelinaRESUMO
BACKGROUND: The outcomes of lung transplantation (LT) are well known in developed countries, but not in Latin America. Our objective was to report the LT experience at a single center in Argentina. METHODS: From June 1994 to February 2003, the 54 LT that were performed included 36 single-lung transplants SLT (45.5%) and 18 double-lung transplants (DSLT) (22.7%). Indications for SLT (n = 36) were emphysema (n = 23) and pulmonary fibrosis (n = 13); for DSLT (n = 18), bronchiectasis (n = 8), cystic fibrosis (n = 8), pulmonary emphysema (n = 1), and bronchiolitis obliterans syndrome caused by graft-versus-host disease after bone-marrow transplantation (n = 1). A univariate analysis, chi-square test with Yates' correction was used for qualitative variables; Wilcoxon-Mann-Whitney test, for quantitative and ordinal variables. Survivals were estimated by the Kaplan-Meier method. RESULTS: In-hospital mortality (HM) was 21.1%. Among SLT, early death was due to sepsis in six patients and by ischemia-reperfusion injury (IRI) and acute rejection in other two. In DSLT, two patients died due to IRI and one, sepsis. The overall estimated survival rates at 1, 2, and 4 years were 70.1% +/- 6.5%, 54.3% +/- 7.2%, and 44.3% +/- 7.9%, respectively. The median overall survival was 26.5 (10 to 34) months. When HM was excluded, survival at 4 years was 51.3% +/- 8.7%. The estimated survival at 3 years was 43.3% +/- 9.3% for SLT and 58.7% +/- 13% for DSLT (P = 6). Survival differences according to the baseline diagnosis were not significant (P =.6). Median follow-up time (percentiles 25 to 75) was 16 (2 to 27) months. CONCLUSIONS: Our LT program shows similar results to those reported by the International Society for Heart and Lung Transplantation for developed countries.
Assuntos
Transplante de Pulmão/estatística & dados numéricos , Argentina , Enfisema/cirurgia , Humanos , Transplante de Pulmão/mortalidade , Preservação de Órgãos/métodos , Fibrose Pulmonar/cirurgia , Estudos Retrospectivos , Análise de SobrevidaRESUMO
El número de pacientes que se incluyen en programas de transplante pulmonar es creciente y su sobrevida en lista de espera depende de la posibilidad de acceder a un TxP así como de la progresión de la enfermedad de base. El objetivo de este trabajo es analizar la evolución y sobrevida de los pacientes con enfermedad respiratoria avanzada (ERA) evaluados para trasplante uni y bipulmonar
Assuntos
Adulto , Transplantes , Transplante de Pulmão , Pneumologia , Estudos RetrospectivosRESUMO
El número de pacientes que se incluyen en programas de transplante pulmonar es creciente y su sobrevida en lista de espera depende de la posibilidad de acceder a un TxP así como de la progresión de la enfermedad de base. El objetivo de este trabajo es analizar la evolución y sobrevida de los pacientes con enfermedad respiratoria avanzada (ERA) evaluados para trasplante uni y bipulmonar
Assuntos
Adulto , Transplante de Pulmão , Pneumologia , Estudos Retrospectivos , TransplantesRESUMO
The purpose of this article is to review the etiological and pathophysiological aspects of chronic severe hypoxemia (CSH) and to determine the indications of long-term oxygen therapy (LTOT). Three hypothesis are presented and analyzed: 1) CSH is harmful to the economy; 2) LTOT is therefore useful; 3) LTOT is not toxic and does not imply major risks than the benefits that it offers. Changes are produced by prolonged exposure to low levels of O2 leading to a sustained increase in pulmonary artery pressure. Secondary pulmonary hypertension (SPH) due to chronic hypoxemia is much more subtle and less symptomatic than that produced by other pathologies. Chronic obstructive pulmonary disease is the most common cause of CSH; these patients have a poor prognosis associated to the hypoxemia and its effects, being a PaO2 below 60 mmHg one of the most precise factors of mortality. Patients selection criteria for LTOT different sources for home oxygen therapy, methods of administration and finally an update of LTOT situation in our country and abroad are discussed.
Assuntos
Hipóxia/terapia , Oxigenoterapia/métodos , Doença Crônica , Feminino , Humanos , Hipóxia/diagnóstico , Hipóxia/fisiopatologia , Masculino , Fatores de TempoRESUMO
The purpose of this article is to review the etiological and pathophysiological aspects of chronic severe hypoxemia (CSH) and to determine the indications of long-term oxygen therapy (LTOT). Three hypothesis are presented and analyzed: 1) CSH is harmful to the economy; 2) LTOT is therefore useful; 3) LTOT is not toxic and does not imply major risks than the benefits that it offers. Changes are produced by prolonged exposure to low levels of O2 leading to a sustained increase in pulmonary artery pressure. Secondary pulmonary hypertension (SPH) due to chronic hypoxemia is much more subtle and less symptomatic than that produced by other pathologies. Chronic obstructive pulmonary disease is the most common cause of CSH; these patients have a poor prognosis associated to the hypoxemia and its effects, being a PaO2 below 60 mmHg one of the most precise factors of mortality. Patients selection criteria for LTOT different sources for home oxygen therapy, methods of administration and finally an update of LTOT situation in our country and abroad are discussed.
RESUMO
A national meeting of specialists in Respiratory Medicine took place with the aim of updating in a consensus the indicating criteria, source and ways of administering Long Term Oxygen Therapy (LTOT). This is the only therapeutic intervention which improves the survival of patients with severe chronic obstructive pulmonary disease and respiratory insufficiency. We regulate its indication in patients with COPD, other obstructive and restrictive diseases, primary and secondary pulmonary hypertension with: 1) PaO2 lower or equal to 55 mmHg breathing air at rest; 2) PaO2 between 56 and 60 mmHg with polyglobulia, cor pulmonale or primary and secondary pulmonary hypertension evaluated in clinical stability by taking two samples of arterial blood gases, with two weeks' difference between them and more than one month after a new acute condition. Patients should receive this therapy more than 15 hours per day (better 24 hours) including sleeping time. Norms of study and indication, were established to set up the requirements of O2 during sleep and exercise. With respect to the sources it was concluded that the O2 concentrator is indicated for patients with very little home movements, and the sources, of O2 liquid for those with active social life. Indications for conventional and non conventional O2 administration were established. Complications and an algorithm of therapeutic failure were determined. Principles which should be contained in a future national law of OCD were delineated.