Heart, lung & circulation
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Heart, lung & circulation · Feb 2008
Case ReportsPulmonary alveolar proteinosis in extremis: the case for aggressive whole lung lavage with extracorporeal membrane oxygenation support.
Pulmonary alveolar proteinosis (PAP) is a rare disorder in which lipoproteinaceous material is deposited in the alveoli, compromising gaseous exchange. We report the case of a 29-year-old female patient presenting with the most extreme case of PAP yet reported. ⋯ Despite critical hypercarbia and ventilator-dependence for 12 days before lavage, the patient experienced rapid recovery of pulmonary function after WLL and ECMO could be discontinued on-table. Aggressive WLL with ECMO support can be safe and effective even in the most severe cases of PAP.
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Heart, lung & circulation · Jan 2008
ReviewClinical practice guidelines for improving outcomes in sepsis.
Sepsis is a common medical condition resulting from an infectious stimulus with a variable inflammatory response leading to a spectrum of clinical conditions from mild constitutional symptoms to varying degrees of organ dysfunction and death. The understanding of the patho-physiology of sepsis has lead to better treatment modalities and whilst sepsis is an increasingly more common condition world wide, the mortality from sepsis is nevertheless falling. Treatment algorithms have been promulgated over the years and levels of evidence for these have varied. This review will focus on the early management issues recently updated and released by a multi-national panel of experts based on best evidence, aimed at reducing sepsis related mortality by 25%.
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Heart, lung & circulation · Jan 2008
ReviewReview of ECMO (extra corporeal membrane oxygenation) support in critically ill adult patients.
Mechanical circulatory support has evolved markedly over recent years. ECMO (extra corporeal membrane oxygenation) is instituted for the management of life threatening pulmonary or cardiac failure (or both), when no other form of treatment has been or is likely to be successful. Most commonly, it is instituted in an emergency or urgent situation after failure of other treatment modalities. ⋯ Its use in premature neonates is the mainstay of treatment for immature lungs and insufficient surfactant. In this review, the technical aspects of ECMO cannulation, maintenance and weaning are outlined. Complication rates and outcomes are reviewed and our experience at The Epworth Hospital is summarized.
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A total of 498 patients underwent open-heart surgery in 2007 with 5 deaths (1%). There was no mortality in 248 patients who had de novo isolated coronary bypass surgery. Major mortality and morbidities were almost exclusively confined to patients over the age of 80 years. The development of new catheter based procedures such as aortic valve replacement is likely to decrease the complication rate and length of hospital stay in this high risk group of patients.
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Heart, lung & circulation · Dec 2007
Case ReportsRecurrent pulmonary microemboli secondary to primary cardiac hydatidosis.
Primary cardiac hydatid cysts are rarely diagnosed and seldom rupture to lungs via pulmonary vein resulting in multifocal cystic lesions. We report a rare instance of an interventricular hydatid cyst. ⋯ Due to extensive distribution of the pulmonary cysts, only the cardiac cyst was taken surgically. The patient remains in our care without any pulmonary improvement despite appropriate medical treatment.