Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine最新文献

{"title":"A Quick Review on the Multisystem Effects of Prone Position in Acute Respiratory Distress Syndrome (ARDS) Including COVID-19.","authors":"Janet O Adeola,&nbsp;Shivani Patel,&nbsp;Evelyne N Goné,&nbsp;George Tewfik","doi":"10.1177/11795484211028526","DOIUrl":"https://doi.org/10.1177/11795484211028526","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this review is to highlight the multisystem effects of prone position in ARDS patients with a focus on current findings regarding its use in COVID-19 patients.</p><p><strong>Methods: </strong>Two reviewers comprehensively searched PubMed database for literature regarding pathophysiology and efficacy of prone position in ARDS patients as well as specific data regarding this approach in COVID-19 patients.</p><p><strong>Conclusion: </strong>Prone positioning is well-documented to improve oxygenation and cardiac function in ARDS patients and might confer increased survival, with benefits that outweigh risks such as facial edema, endotracheal tube displacement, and intraabdominal organ dysfunction in obese patients. Severe COVID-19 pneumonia, while meeting ARDS criteria, differs from typical ARDS in several ways. Data would suggest that advantages of prone position would become limited after significant disease progression and fibrosis. The use of this technique in COVID-19 requires prolonged sessions that are unprecedented in the treatment of ARDS patients. New data regarding COVID-19 pathophysiology and patients continues to evolve daily. More frequently, patients are proned while maintaining spontaneous breathing-the results of this intervention are an area for future studies. There is more to learn about the appropriate use of prone position in COVID-19 patients. The multisystem risks and benefits require clinicians to adopt a patient centered decision-making algorithm when employing this technique in COVID-19 patients.</p><p><strong>Level of evidence: </strong>NA.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11795484211028526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39195561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delphi Consensus Recommendations on Management of Dosing, Adverse Events, and Comorbidities in the Treatment of Idiopathic Pulmonary Fibrosis with Nintedanib.","authors":"Franck Rahaghi,&nbsp;John A Belperio,&nbsp;John Fitzgerald,&nbsp;Mridu Gulati,&nbsp;Robert Hallowell,&nbsp;Kristin B Highland,&nbsp;Tristan J Huie,&nbsp;Hyun J Kim,&nbsp;Martin Kolb,&nbsp;Joseph A Lasky,&nbsp;Brian D Southern,&nbsp;Jeffrey J Swigris,&nbsp;Joao A de Andrade","doi":"10.1177/11795484211006050","DOIUrl":"https://doi.org/10.1177/11795484211006050","url":null,"abstract":"<p><strong>Purpose: </strong>Nintedanib is an approved treatment for idiopathic pulmonary fibrosis (IPF), which slows disease progression. Management of patients with IPF receiving nintedanib can be complicated by tolerability issues, comorbidities, and concomitant medications. We developed consensus recommendations on the management of dosing, adverse events and comorbidities in patients with IPF treated with nintedanib.</p><p><strong>Methods: </strong>A modified Delphi process using 3 questionnaires was used to survey 14 pulmonologists experienced in using nintedanib. Panelists rated their agreement with statements on a Likert scale from -5 (strongly disagree) to +5 (strongly agree). Consensus was predefined as a mean score of ⩽-2.5 or ⩾+2.5 with a standard deviation not crossing zero.</p><p><strong>Results: </strong>The panelists' recommendations were largely aligned with clinical trial data, real-world evidence, and the prescribing information, and provided additional guidance regarding minimizing gastrointestinal effects, periodic monitoring for liver dysfunction, caution with respect to concomitant administration of cytochrome P450 3A4 and P-glycoprotein 1 inhibitors and inducers and anticoagulants, and management of comorbidities. The panelists unanimously agreed that adverse event management should be individualized, based on careful consideration of the risks and benefits of each possible intervention and discussion with the patient.</p><p><strong>Conclusions: </strong>These consensus recommendations provide additional guidance on the appropriate management of IPF with nintedanib, for use alongside evidence-based literature and the prescribing information.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2021-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11795484211006050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25589497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation and Predicted Equations of MIP/MEP from the Pulmonary Function, Demographics and Anthropometrics in Healthy Thai Participants aged 19 to 50 Years.","authors":"Thanyaluck Sriboonreung,&nbsp;Jirakrit Leelarungrayub,&nbsp;Araya Yankai,&nbsp;Rungthip Puntumetakul","doi":"10.1177/11795484211004494","DOIUrl":"https://doi.org/10.1177/11795484211004494","url":null,"abstract":"<p><strong>Objective: </strong>To identify the correlations and possible predicted equations of maximal inspiratory (MIP) and expiratory mouth pressure (MEP) values from pulmonary function test (PFT), demographics, and anthropometrics.</p><p><strong>Methods: </strong>This study involved 217 healthy participants (91 males and 126 females) aged 19 to 50 years. The PFT (forced vital capacity; FVC, forced expiratory volume in 1 second; FEV1, maximal mid-expiratory flow; MMEF, and peak expiratory flow; PEF) was performed by spirometry, whereas MIP and MEP were evaluated by a respiratory pressure meter. Pearson correlation and multiple linear regression, with the stepwise method, were used for statistical analysis.</p><p><strong>Results: </strong>The MIP and MEP had a significant positive correlation with weight, height, body mass index (BMI), and waist circumference. MIP had a significant positive correlation with FVC (%) and PEF (L/s and %), as well as a negative correlation with FEV1/FVC (ratio and %) and MMEF (%). Whereas, MEP showed a significant positive correlation with PEF (L/s and %) and negative correlation with FEV1/FVC (ratio and %) and MMEF (L/s). Finally, the predicted MIP and MEP equations were 103.988-97.70 × FEV1/FVC + 31.292 × Sex (male = 1 and female = 0) + 0.662 × PEF (%) and 47.384 + 3.603 × PEF (L/s)-9.514 × MMEF(L/s) + 30.458 × Sex (male = 1 and female = 0) + 0.534 × PEF (%), respectively.</p><p><strong>Conclusion: </strong>The respiratory muscle strengths can be predicted from the pulmonary function test, and gender data.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2021-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11795484211004494","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25557530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Systemic Sclerosis Patients in the COVID-19 Era: The Experience of an Expert Specialist Reference Center.","authors":"Amelia Spinella,&nbsp;Luca Magnani,&nbsp;Marco De Pinto,&nbsp;Chiara Marvisi,&nbsp;Luca Parenti,&nbsp;Gianluigi Bajocchi,&nbsp;Carlo Salvarani,&nbsp;Maria Teresa Mascia,&nbsp;Dilia Giuggioli","doi":"10.1177/11795484211001349","DOIUrl":"https://doi.org/10.1177/11795484211001349","url":null,"abstract":"<p><strong>Objective: </strong>COVID-19 pandemic represents a serious health emergency that severely compromised our Public Health system, resulting in a rapid and forced reorganization and involved the management of chronic diseases too. The Scleroderma Unit of Modena and Reggio Emilia follows more than 600 patients suffering from systemic sclerosis (SSc) and recently became the referral center (HUB) in Emilia-Romagna for this rare connective tissue disease. The aim of the present study was to evaluate the extent by which the lockdown and the pandemic has impacted the activity of admissions to Scleroderma Unit of Modena and Reggio Emilia.</p><p><strong>Methods: </strong>Our daily clinical activity is characterized by outpatient visits, videocapillaroscopy exam, ulcers treatment, therapeutic infusions in day hospital regimen, multidisciplinary visits following our dedicated SSc care pathway, and clinical trials. Our activity has been quickly rescheduled to ensure the proper assistance to our SSc patients during the COVID-19 pressure.</p><p><strong>Results: </strong>The use of telemedicine has certainly assured a robust continuity of health care. Furthermore, telephone pre-triage, nurse/medical triage, proper physical distancing and use of PPE/DPI allowed us to re-organize and continue SSc daily activity. Specifically, therapeutic infusions in day hospital regimen and outpatient visits, including ulcers treatment, was guaranteed and maximized.</p><p><strong>Conclusion: </strong>The management of scleroderma patients by an expert specialist reference center is crucial in order to ensure continuity of care and pursue the best SSc practice.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2021-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11795484211001349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25551145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forty-One-Year-Old Man with Pulmonary Embolism 5 Months After COVID-19.","authors":"Muhanad Taha,&nbsp;Paul Nguyen,&nbsp;Aditi Sharma,&nbsp;Mazen Taha,&nbsp;Lobelia Samavati","doi":"10.1177/1179548420986659","DOIUrl":"https://doi.org/10.1177/1179548420986659","url":null,"abstract":"<p><strong>Background: </strong>Hypercoagulation is one of the striking features of COVID-19. Patients hospitalized with COVID-19 are at high risk for venous thromboembolism. However, it is unknown if the risk for venous thromboembolism persists after discharge.</p><p><strong>Case summary: </strong>We report a case with pulmonary embolism 5 months after COVID-19. No risk factors for venous thrombosis have been identified.</p><p><strong>Conclusion: </strong>In COVID-19 related hospitalization, large studies are needed to identify the risk of venous thromboembolism after discharge.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179548420986659","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25398784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Related Cardiovascular Comorbidities and Complications in Critically Ill Patients: A Systematic Review and Meta-analysis.","authors":"Michael Koeppen,&nbsp;Peter Rosenberger,&nbsp;Harry Magunia","doi":"10.1177/1179548421992327","DOIUrl":"https://doi.org/10.1177/1179548421992327","url":null,"abstract":"<p><strong>Objective: </strong>This systematic-review and meta-analysis aimed to assess the prevalence of cardiovascular comorbidities and complications in ICU-admitted coronavirus disease 2019 (COVID-19) patients.</p><p><strong>Data sources: </strong>PubMed and Web of Science databases were referenced until November 25, 2020.</p><p><strong>Data extraction: </strong>We extracted retrospective and prospective observational studies on critically ill COVID-19 patients admitted to an intensive care unit. Only studies reporting on cardiovascular comorbidities and complications during ICU therapy were included.</p><p><strong>Data synthesis: </strong>We calculated the pooled prevalence by a random-effects model and determined heterogeneity by Higgins' <i>I</i> ² test.</p><p><strong>Results: </strong>Of the 6346 studies retrieved, 29 were included in this review. The most common cardiovascular comorbidity was arterial hypertension (50%; 95% confidence interval [CI], 0.42-058; <i>I</i> ² = 94.8%, low quality of evidence). Among cardiovascular complications in the ICU, shock (of any course) was most common, being present in 39% of the patients (95% CI, 0.20-0.59; <i>I</i> ² = 95.6%; 6 studies). Seventy-four percent of patients in the ICU required vasopressors to maintain target blood pressure (95% CI, 0.58-0.88; <i>I</i> ² = 93.6%; 8 studies), and 30% of patients developed cardiac injury in the ICU (95% CI, 0.19-0.42; <i>I</i> ² = 91%; 14 studies). Severe heterogeneity existed among the studies.</p><p><strong>Conclusions: </strong>Cardiovascular complications are common in patients admitted to the intensive care unit for COVID-19. However, the existing evidence is highly heterogeneous in terms of study design and outcome measurements. Thus, prospective, observational studies are needed to determine the impact of cardiovascular complications on patient outcome in critically ill COVID-19 patients.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179548421992327","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9178803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spotlight on New Antibiotics for the Treatment of Pneumonia.","authors":"Alessandro Russo","doi":"10.1177/1179548420982786","DOIUrl":"https://doi.org/10.1177/1179548420982786","url":null,"abstract":"<p><p>In the last years, the presence of multidrug-resistant (MDR) Gram-negative (like <i>Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii</i>) and Gram-positive bacteria (mostly methicillin-resistant <i>Staphylococcus aureus</i>) was worldwide reported, limiting the options for an effective antibiotic therapy. For these reasons, inappropriate antimicrobial therapy and delayed prescription can lead to an unfavorable outcome, especially in patients with pneumonia. New antibiotics approved belong to classes of antimicrobials, like beta-lactams with or without beta-lactamase inhibitors, aminoglycosides, oxazolidinones, quinolones, and tetracyclines, or based on new mechanisms of action. These new compounds show many advantages, including a broad spectrum of activity against MDR pathogens, good lung penetration, safety and tolerability, and finally the possibility of intravenous and/or oral formulations. However, the new antibiotics under development represent an important possible armamentarium against difficult-to-treat strains. The safety and clinical efficacy of these future drugs should be tested in clinical practice. In this review, there are reported characteristics of newly approved antibiotics that represent potential future options for the treatment of respiratory tract infections, including those caused by multidrug-resistant bacteria. Finally, the characteristics of the drugs under development are briefly reported.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2020-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179548420982786","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38802172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Experience With Methylprednisolone on SARS-CoV-2 Infection in the African American Population, a Retrospective Analysis.","authors":"Subodh J Saggi, Sridesh Nath, Roshni Culas, Seema Chittalae, Aaliya Burza, Maya Srinivasan, Rishard Abdul, Benjamin Silver, Alnardo Lora, Ishmam Ibtida, Tanuj Chokshi, Violeta Capric, Ammar Mohamed, Samrat Worah, Jie OuYang, Patrick Geraghty, Angelika Gruessner, Moro O Salifu","doi":"10.1177/1179548420980699","DOIUrl":"10.1177/1179548420980699","url":null,"abstract":"<p><strong>Background: </strong>Coronavirus disease-19 (COVID-19) is associated with acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS) with high mortality rates. In African American (AA) populations, COVID-19 presentations and outcomes are more severe. NIH and Interim WHO guidelines had suggested against the use of corticosteroids unless in clinical trials until the recent publication of the RECOVERY trial. Here, we analyzed the treatment effect of methylprednisolone on patients with AKI and ARDS during the initial 2 months of COVID-19 and detail the learning effect within our institution.</p><p><strong>Methods: </strong>Between March 1 and April 30, 2020, 75 AA patients met our inclusion criteria for ARDS and AKI, of which 37 had received corticosteroids. Twenty-eight-day mortality, improvement in PaO₂/FiO₂ ratio, and renal function were analyzed. The impact of methylprednisolone treatment was assessed with multivariable methods.</p><p><strong>Results: </strong>Survival in the methylprednisolone group reached 51% at 21 days compared to 29% in the non-corticosteroid group (<i>P</i> < .001). Methylprednisolone improved the likelihood of renal function improvement. PaO₂/FiO₂ ratio in the methylprednisolone group improved by 73% compared to 45% in the non-corticosteroid group (<i>P</i> = .01). Age, gender, BMI, preexisting conditions, and other treatment factors did not show any impact on renal or PaO₂/FiO₂ ratio improvement. The use of anticoagulants, the month of treatment, and AKI during hospitalization also influenced outcomes.</p><p><strong>Conclusion: </strong>In AA COVID-19 positive patients with ARDS and AKI, IV methylprednisolone lowered the incidence of mortality and improved the likelihood of renal and lung function recovery. Further investigation with a randomized control trial of corticosteroids is warranted.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2020-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179548420980699","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38784493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right-to-left Ventricular Diameter Ratio At Computed Tomographic Pulmonary Angiography in Patients with Acute Pulmonary Embolism and Obstructive Sleep Apnea.","authors":"Thomas M Berghaus,&nbsp;Fabian Geissenberger,&nbsp;Dinah Konnerth,&nbsp;Michael Probst,&nbsp;Thomas Kröncke,&nbsp;Florian Schwarz","doi":"10.1177/1179548420976430","DOIUrl":"https://doi.org/10.1177/1179548420976430","url":null,"abstract":"<p><strong>Purpose: </strong>Right ventricular (RV) dysfunction in acute pulmonary embolism (PE) is a critical determinant of outcome. Obstructive sleep apnea (OSA) is a common comorbidity of PE and might also affect RV function. Therefore, we sought to investigate RV dysfunction in PE patients in proportion to the severity of OSA by evaluating the right-to-left ventricular (RV/LV) diameter ratio on computed tomographic pulmonary angiography (CTPA).</p><p><strong>Materials and methods: </strong>197 PE patients were evaluated for sleep-disordered breathing by portable monitoring and nocturnal polysomnography. RV dilatation was defined as an RV/LV diameter ratio of ⩾ 1.0.</p><p><strong>Results: </strong>RV dilatation was significantly more frequent in OSA patients compared to study participants without OSA (66.4% vs 49.1%, <i>P</i> = .036). Elevated troponin I values, indicating myocardial injury due to acute, PE-related RV strain, were significantly more frequent in OSA patients with an apnea-hypopnea index (AHI) ⩾ 15/h compared to those with an AHI < 15/h (62.1% vs 45.8%, <i>P</i> = .035). However, RV dysfunction documented by the RV/LV diameter ratio on CTPA was not significantly associated with the severity of OSA in multivariable regression analysis.</p><p><strong>Conclusion: </strong>Patients with moderate or severe OSA might compensate acute, PE-related RV strain better, as they are adapted to repetitive right heart pressure overloads during sleep.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2020-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179548420976430","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38743901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperammonemia Post Lung Transplantation: A Review.","authors":"Robert F Leger, Matthew S Silverman, Ellen S Hauck, Ksenia D Guvakova","doi":"10.1177/1179548420966234","DOIUrl":"10.1177/1179548420966234","url":null,"abstract":"<p><p>Hyperammonemia is the pathological accumulation of ammonia in the blood, which can occur in many different clinical settings. Most commonly in adults, hyperammonemia occurs secondary to hepatic dysfunction; however, it is also known to be associated with other pathologies, surgeries, and medications. Although less common, hyperammonemia has been described as a rare, but consistent complication of solid organ transplantation. Lung transplantation is increasingly recognized as a unique risk factor for the development of this condition, which can pose grave health risks-including long-term neurological sequelae and even death. Recent clinical findings have suggested that patients receiving lung transplantations may experience postoperative hyperammonemia at rates as high as 4.1%. A wide array of etiologies has been attributed to this condition. A growing number of case studies and investigations suggest disseminated opportunistic infection with Ureaplasma or Mycoplasma species may drive this metabolic disturbance in lung transplant recipients. Regardless of the etiology, hyperammonemia presents a severe clinical problem with reported mortality rates as high as 75%. Typical treatment regimens are multimodal and focus on 3 main avenues of management: (1) the reduction of impact on the brain through the use of neuroprotective medications and decreasing cerebral edema, (2) augmentation of mechanisms for the elimination of ammonia from the blood via hemodialysis, and (3) the diminishment of processes producing predominantly using antibiotics. The aim of this review is to detail the pathophysiology of hyperammonemia in the setting of orthotopic lung transplantation and discuss methods of identifying and managing patients with this condition.</p>","PeriodicalId":44269,"journal":{"name":"Clinical Medicine Insights-Circulatory Respiratory and Pulmonary Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2020-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179548420966234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38709158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}