B. Mankidy

Emerging drugs in lung transplantation.

The balance between immunosuppression to ensure graft tolerance while preventing emergence of infectious complications is key in lung transplantation. Although opportunistic infection may appear to be the most important of these complications, malignancies and severe drug toxicities significantly affect the short- and long-term outcomes of the patients. The present practice is combination therapy using drugs with complementary immunosuppressive action, to achieve synergistic immunosuppression with the lowest possible toxicity. Components of immunosuppression include induction and maintenance regimens. Primary graft failure remains an important cause of mortality and morbidity in the immediate post-transplant period. Acute rejection is a common complication after lung transplant, but responds well to augmented immunosuppression and immunomodulation. Chronic rejection still is the major cause of mortality in patients who survive the initial year post-transplantation. Several new drugs have shown promise in decreasing the rate of loss of graft function. This review discusses the current and emerging therapeutic regimens.

REDUCTION IN IN-HOSPITAL CARDIAC ARREST WITH EARLY INTERVENTIONS IN THE EMERGENCY DEPARTMENT AND NON-ICU UNITS BY A NOVEL APPROACH OF RAPID RESPONSE TEAMS (RRT) AND MOBILE ICU MANAGEMENT

METHODS: The study was conducted at Baylor St Luke’s Medical center, an 850-bed quaternary and academic medical center in Houston, Texas. Patients in the emergency department and non-ICU units that met the criteria of decompensation were evaluated by RRT. RRT consisted of a team of experienced nurses specifically trained in medical emergency response. If needed, RRT requested immediate management by the Mobile ICU team which had extended scope of ICU interventions and was made up of a critical care attending physician, critical care fellow and a mid-level provider. The advanced ICU capabilities included obtaining point of care labs including lactic acid levels, portable ultrasound, airway management, and resuscitation capabilities such as placing central lines, rapid infusers and initiation of pressors. A mobile procedure cart was specifically built for this purpose and was stationed in the emergency department and in the hospital wards. Patients were transferred to the ICU as soon as beds became available. Retrospective analysis of a cohort of patients from January 2013 to September 2014 (Cohort A) when only RRT services had been rolled out, was compared with a cohort of patients from October 2014 to December 2017 (Cohort B) when Mobile ICU service was implemented as well.