Excited to share our summary on pulmonary rehabilitation, an underutilized and critically important treatment that can help our patients with chronic respiratory disease. Thanks to my coauthors Drs. Davis and @RestivoAnderson!
This JAMA Clinical Guidelines Synopsis summarizes the American Thoracic Society’s 2023 guidelines on pulmonary rehabilitation for adults with chronic respiratory disease.
ja.ma/4jNGC6i
What started as a clinical ? during training turned into a lifelong passion for research & education. With support of mentors, colleagues & especially my trainees, I celebrated my promotion to Professor at Harvard. I could not have done it w/o the support of my amazing fam ❤️
🔎Conventional DBD v cDCD in🇨🇭: DBD correlated w/⬆️ ⏰ vent, ⬆️90d mortality. cDCD assoc w/⬆️LOS. BUT late outcomes w/o significant diff b/t groups (marginally superior 1yr mortality but early CLAD in cDCD cohort)
- Can we safely follow suit?
- Can this ⬆️access to pediatric pts?
Congratulations to the presenters on fantastic work: Armaan Akbaar (JHU), Irene Bello (Hosp Clinic Barcelona), Sanjay Dutta (Sydney), Lucas Hoyos Mejia (Univ Hosp Zurich), Kevin Kulshrestha (Cincinnati Children’s)
🔎We use mechanical insufflation/exsufflation routinely for critically ill patients. One group performed blinded RCT of MIE on organ donors, which ⬆️ % of eligible lung donors!
- Can we use this to ⬆️ donor pool?
- What’s stopping us from universal implementation?
🔎Extended criteria donors⬆️ pool, but significant regional variation in acceptable age. Single center eval don >68YO vs not. No difference in rates of post-op ECMO, LOS (ICU or hosp), or 30d mortality, overall death.
- So what’s stopping us?
🔎Rates of intraop 🫁 turndown after initial acceptance have ⬆️ to up to 10% at some institutions in the last 20 yrs
- Can we improve communication b/t OPO & txp centers prior to transport/travel?
- What are the reasons behind 🫁decline?
- How will this change in the CAS era?
A💥RAPID FIRE💥 session on the 🔒 safe preservation, transportation 🚑🚁, and evaluation 📝 of the donor lung 🫁 especially given implementation of CAS which can potentially ⬆️ transport and ischemic times
🔑 takeaways and things to think about 💭🤔
@ISHLT#ISHLT2024
💥ML CNN-based models accurately predicted future lung fxn during EVLP assessments w/no difference in predicted EVLP outcome using actual or simulated vent data.
❓How do we optimally implement ML to replace the control arm of clx trials w/ digital lung simulations?
Thank you for sharing your work!
Armaan Akbar (JHU)
Toshihoro Okamoto (Cleveland clinic)
Carli Lehr(Cleveland Clinic)
Mena Botros(Houston Methodist)
Howard Huang(Houston Methodist)
Ismail Cenik(KU Leuven)
Morgan Hill(MUSC)
Gabriel Loor(Baylor)
Emily Larson(JHU)
Xuanzi Zhou(UHN)
This afternoon @ISHLT#ISHLT2024 is ALL about the optimization of the allograft pre-transplant!
A session on novel developments in ex vivo lung perfusion (EVLP) for 🫁♻️ and efforts around lung preservation. Read on! 🤓
cfDNA reflects lung injury post txp. What are the implications of concentration of cfDNA at 1 hr in EVLP perfusate on outcomes?
⬆️ cfDNA concentration in perfusate results in a HIGHER rate of organ decline for transplant
Haruchika Yamamoto (Toronto)