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Prolonged Mechanical Ventilation After Lung Transplantation—A Single‐Center Study
Author(s) -
Hadem J.,
Gottlieb J.,
Seifert D.,
Fegbeutel C.,
Sommer W.,
Greer M.,
Wiesner O.,
Kielstein J. T.,
Schneider A. S.,
Ius F.,
Fuge J.,
Kühn C.,
Tudorache I.,
Haverich A.,
Welte T.,
Warnecke G.,
Hoeper M. M.
Publication year - 2016
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13632
Subject(s) - medicine , lung transplantation , mechanical ventilation , single center , transplantation , lung , intensive care medicine , ventilation (architecture) , surgery , anesthesia , mechanical engineering , engineering
This single‐center study examines the incidence, etiology, and outcomes associated with prolonged mechanical ventilation ( PMV ), defined as time to definite spontaneous ventilation >21 days after double lung transplantation ( LT x). A total of 690 LT x recipients between January 2005 and December 2012 were analyzed. PMV was necessary in 95 (13.8%) patients with decreasing incidence during the observation period (p < 0.001). Independent predictors of PMV were renal replacement therapy (odds ratio [ OR ] 11.13 [95% CI , 5.82–21.29], p < 0.001), anastomotic dehiscence ( OR 8.74 [95% CI 2.42–31.58], p = 0.001), autoimmune comorbidity ( OR 5.52 [95% CI 1.86–16.41], p = 0.002), and postoperative neurologic complications ( OR 5.03 [95% CI 1.98–12.81], p = 0.001), among others. Overall 1‐year survival was 86.0% (90.4% for LT x between 2010 and 2012); it was 60.7% after PMV and 90.0% in controls (p < 0.001). Conditional long‐term outcome among hospital survivors, however, did not differ between the groups (p = 0.78). Multivariate analysis identified renal replacement therapy (hazard ratio [HR] 3.55 [95% CI 2.40–5.25], p < 0.001), post‐ LT x extracorporeal membrane oxygenation ( HR 3.47 [95% CI 2.06–5.83], p < 0.001), and prolonged inotropic support ( HR 1.95 [95% CI 1.39–2.75], p < 0.001), among others, as independent predictors of mortality. In conclusion, PMV complicated 14% of LT x procedures and, although associated with increased in‐hospital mortality, outcomes among patients surviving to hospital discharge were unaffected.