Immediate postoperative extubation in bilateral lung transplantation: predictive factors and outcomes
| Autor: | Benjamin Zuber, François Parquin, M. Fischler, A. Roux, Marie-Louise Felten, Jean-Denis Moyer, Jean-François Dreyfus, Jean-Yves Marandon, M. Le Guen, Charles Cerf, Edouard Sage |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Operating Rooms medicine.medical_specialty Adolescent Critical Care Cystic Fibrosis medicine.medical_treatment Primary Graft Dysfunction 030204 cardiovascular system & hematology Cystic fibrosis law.invention Cohort Studies Young Adult 03 medical and health sciences Postoperative Complications 0302 clinical medicine Tracheal extubation Predictive Value of Tests law Humans Medicine Lung transplantation Arterial Pressure Blood Transfusion Aged Retrospective Studies Lung business.industry Bilateral lung transplantation Length of Stay Middle Aged medicine.disease Intensive care unit One-Lung Ventilation Surgery Oxygen Treatment Outcome Anesthesiology and Pain Medicine medicine.anatomical_structure 030228 respiratory system Anesthesia Airway Extubation Female Transplant patient business Lung Transplantation |
| Zdroj: | British Journal of Anaesthesia. 116:847-854 |
| ISSN: | 0007-0912 |
| Popis: | We reviewed our experience with tracheal extubation in the operating room (E-OR) among cystic fibrosis patients requiring bilateral lung transplantation to evaluate safety and determine predictive factors of E-OR.The charts of 89 recipients (from May 2007 to June 2013) were analysed. Patients were divided into E-OR and E-ICU (intensive care unit extubation) groups. Data are expressed as numbers (percentages) or medians [25th-75th percentiles].There were 41 patients in the E-OR group (46%). Donor and recipient characteristics were similar between groups. Intraoperative complications occurred less frequently in the E-OR group, and fluid and transfusion requirements were lower. Postoperative courses were different in the E-OR group, including a lower rate of grade 3 primary graft dysfunction (0 compared with 19 patients, P0.0001) and shorter ICU (5.0 [3.7-7.2] compared with 11.5 [7.0-15.5] days) and hospital stays (22.0 [18.0-25.5] compared with 33.0 [25.0-56.5] days, respectively; P0.0001 for both). The 1 yr survival rates were similar: 95% in the E-OR group and 98% in the E-ICU group. A statistical model built on a development cohort of 60 randomly selected patients predicted 95% of E-OR instances in this cohort and 82% of E-OR instances in the validation cohort (28 patients). Predictive factors were complications during single-lung ventilation (second graft implantation), complications during bipulmonary ventilation (end of surgery), and the ratio of arterial partial pressure of oxygen to fractional inspired oxygen (end of surgery).Our protocol allowed for extubation of 46% of bilateral lung transplant patients without increased postoperative risks. |
| Databáze: | OpenAIRE |
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