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provement), optimal setting (hierarchic approach to operative location, enhanced PPE), optimal procedure and management after tracheostomy (McGrath 2020).
Lung Transplantation As in other terminal lung diseases, lung transplantation (LTX) can be a potential therapeutic option. Of course, the indication needs to be considered especially careful. In an editorial published in August 2020, the authors list ten considerations that they believe should be carefully weighed when assessing a patient with COVID-19-associated ARDS regarding potential candidacy for lung transplantation (< 65 years, only single-organ dysfunction, sufficient time for lung recovery, radiological evidence of irreversible lung disease, such as severe bullous destruction or established fibrosis, etc) (Cypel 2020). Up to now, only case reports have been published. After 52 days of critical COVID-19, ECMO and several complications, a comprehensive interdisciplinary discussion on the direction of treatment resulted in a consensus that the lungs of the otherwise healthy 44-year-old woman from Klagenfurt, Austria had no potential for recovery. On day 58, a suitable donor organ became available, and a sequential bilateral lung transplant was performed. At day 144, the patient remained well. Despite the success of this case, the authors emphasize that lung transplantation is an option for only a small proportion of patients (Lang 2020).
References Bhimraj A, Morgan RL, Shumaker AH, et al. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Clin Infect Dis. 2020 Apr 27:ciaa478. PubMed: https://pubmed.gov/32338708. Full-text: https://doi.org/10.1093/cid/ciaa478 | Version 3.3.0, last updated 25.09.2020. Full-text: https://www.idsociety.org/COVID19guidelines Caputo ND, Strayer RJ, Levitan R. Early Self-Proning in Awake, Non-intubated Patients in the Emergency Department: A Single ED´s Experience during the COVID-19 Pandemic. Acad Emerg Med. 2020 Apr 22. PubMed: https://pubmed.gov/32320506. Full-text: https://doi.org/10.1111/acem.13994 Cummings MJ, Baldwin MR, Abrams D, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020 May 19:S0140-6736(20)31189-2. PubMed: https://pubmed.gov/32442528. Full-text: https://doi.org/10.1016/S0140-6736(20)31189-2 Cypel M, Keshavjee S. When to consider lung transplantation for COVID-19. Lancet Resp Med, August 25, 2020. Full-text: https://doi.org/10.1016/S2213-2600(20)30393-3 Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020 May 22;369:m1985. PubMed: https://pubmed.gov/32444460. Full-text: https://doi.org/10.1136/bmj.m1985
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