Prolonged mechanical ventilation after lung transplantation: risks factors and consequences on recipient outcome

Frontiers in Medicine

Medicine

Sylvain Jean-Baptiste¹  Brice Lortat-Jacob¹  Aimane Boughaba¹  Léa Copelovici¹  Enora Atchade¹  Alexy Tran Dinh²  Christian de Tymowski³  Sébastien Tanaka⁴  Philippe Montravers⁵  Arnaud Roussel⁶  Yves Castier⁷  Jonathan Messika⁸  Hervé Mal⁹ 

[1] APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France;APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France;INSERM U1148, LVTS, CHU Bichat-Claude Bernard, Paris, France;Université de Paris, UFR Diderot, Paris, France;APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France;INSERM UMR 1149, Immunorecepteur et Immunopathologie Rénale, CHU Bichat-Claude Bernard, Paris, France;APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France;Université De La Réunion, INSERM UMR 1188, Diabète Athérothrombose Réunion Océan Indien (DéTROI), Saint-Denis de la Réunion, France;APHP, CHU Bichat-Claude Bernard, DMU PARABOL, Paris, France;Université de Paris, UFR Diderot, Paris, France;INSERM UMR 1152, Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France;APHP, CHU Bichat-Claude Bernard, Service de Chirurgie Thoracique et Vasculaire, 46 rue Henri Huchard, Paris, France;Université de Paris, UFR Diderot, Paris, France;APHP, CHU Bichat-Claude Bernard, Service de Chirurgie Thoracique et Vasculaire, 46 rue Henri Huchard, Paris, France;INSERM UMR 1152, Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France;Université de Paris, UFR Diderot, Paris, France;APHP, CHU Bichat-Claude Bernard, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France;Université de Paris, UFR Diderot, Paris, France;INSERM UMR 1152, Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France;APHP, CHU Bichat-Claude Bernard, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France;

关键词: lung transplantation;    intensive care unit;    prolonged mechanical ventilation;    outcome;    one-year mortality;   

DOI  :  10.3389/fmed.2023.1160621

 received in 2023-02-07, accepted in 2023-04-19,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundRisk factors and the incidence of prolonged mechanical ventilation (PMV) after lung transplantation (LT) have been poorly described. The study assessed predictive factors of PMV after LT.MethodsThis observational, retrospective, monocentric study included all patients who received LT in Bichat Claude Bernard Hospital between January 2016 and December 2020. PMV was defined as a duration of MV > 14 days. Independent risk factors for PMV were studied using multivariate analysis. One-year survival depending on PMV was studied using Kaplan Meier and log-rank tests. A p value <0.05 was defined as significant.Results224 LT recipients were analysed. 64 (28%) of them received PMV for a median duration of 34 [26–52] days versus 2 [1–3] days without PMV. Independent risk factors for PMV were higher body mass index (BMI) (p = 0.031), diabetes mellitus of the recipient (p = 0.039), ECMO support during surgery (p = 0.029) and intraoperative transfusion >5 red blood cell units (p < 0.001). Increased mortality rates were observed at one-year in recipients who received PMV (44% versus 15%, p < 0.001).ConclusionPMV was associated with increased morbidity and mortality one-year after LT. Preoperative risk factors (BMI and diabetes mellitus) must be considered when selecting and conditioning the recipients.

【 授权许可】

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Copyright © 2023 Atchade, Boughaba, Dinh, Jean-Baptiste, Tanaka, Copelovici, Lortat-Jacob, Roussel, Castier, Messika, Mal, Tymowski and Montravers.