Early Tracheostomy Following Lung Transplantation

Feltracco, Paolo; Milevoj, M.; Alberti, Vittorio; Carollo, Cristiana; Michieletto, Elisa; Rea, Federico; Loy, Monica; Marulli, Giuseppe; Ori, Carlo

doi:10.1016/j.transproceed.2011.01.154

Cited by 26 publications

(16 citation statements)

References 11 publications

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“…In these cases early tracheostomy is often performed 79–81 . This allows for safe weaning trials that lessen the risk of airway complications from repeated intubations and constant high pressure on the bronchial anastomoses 79–81 . Patients also have better comfort, oral hygiene, clearance of pulmonary secretions and a lower risk of vocal cord injury.…”

Section: Lung Transplant Specific Issues In Mechanical Ventilation Ofmentioning

confidence: 99%

Mechanical ventilation for the lung transplant recipient

et al. 2015

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Mechanical ventilation (MV) is an important aspect in the intraoperative and early postoperative management of lung transplant (LTx)-recipients. There are no randomized-controlled trials of LTx-recipient MV strategies; however there are LTx center experiences and international survey studies reported. The main early complication of LTx is primary graft dysfunction (PGD), which is similar to the adult respiratory distress syndrome (ARDS). We aim to summarize information pertinent to LTx-MV, as well as PGD, ARDS, and intraoperative MV and to synthesize these available data into recommendations. Based on the available evidence, we recommend lung-protective MV with low-tidal-volumes (≤6 mL/kg predicted body weight [PBW]) and positive end-expiratory pressure for the LTx-recipient. In our opinion, the MV strategy should be based on donor characteristics (donor PBW as a parameter of actual allograft size), rather than based on recipient characteristics; however this donor-characteristics-based protective MV is based on indirect evidence and requires validation in prospective clinical studies.

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Section: Lung Transplant Specific Issues In Mechanical Ventilation Ofmentioning

confidence: 99%

Mechanical ventilation for the lung transplant recipient

et al. 2015

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“…Tracheostomy is a useful and safe management option for patients requiring prolonged mechanical ventilator support after lung transplant. Tracheostomy shows similar short‐term outcomes after lung transplantation using both open and percutaneous tracheostomy techniques . In patients with respiratory failure, early tracheostomy is associated with less risk of ventilator‐associated pneumonia, decreased time on mechanical ventilation, and decreased ICU length of stay …”

Section: Introductionmentioning

confidence: 92%

“…A large randomized clinical trial of non‐surgical patients requiring prolonged mechanical ventilation failed to demonstrate any mortality benefit from early tracheostomy compared with late tracheostomy . However, non‐randomized studies in postoperative cardiac surgery patients suggest that early tracheostomy is associated with improved outcomes and decreased mortality…”

Section: Commentmentioning

confidence: 99%

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Need for tracheostomy after lung transplant predicts decreased mid‐ and long‐term survival

Huddleston

Brown

Rudser

et al. 2019

Clinical Transplantation

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Background: Tracheostomy is an important adjunct for lung transplant patients requiring prolonged ventilation. We explored the effects of post-transplant tracheostomy on survival and bronchiolitis obliterans syndrome after lung transplant. Methods: A retrospective, single center analysis was performed on all lung transplant recipients during the Lung Allocation Score (LAS) era. Risk factors for post-transplant tracheostomy or death within 30 days were assessed. Kaplan-Meier estimates and Cox proportional hazards models were used to examine the association between tracheostomy within 30 days after transplant and survival at 1 and 3 years. A total of 403 patients underwent single or bilateral lung transplant between May 2005 and February 2016 with complete data for 352 cases, and 35 patients (9.9%) underwent tracheostomy or died (N = 10, 2.8%) within 30 days. Results: In adjusted analyses, primary graft dysfunction grade 3 (PGD3) was associated with a composite end point of tracheostomy or death within 30 days (HR 3.11 (1.69, 5.71), P-value < .001). Tracheostomy within 30 days was associated with decreased survival at 1(HR 4.25 [1.75, 10.35] P-value = .001) and 3 years (HR 2.74 [1.30, 5.76], P-value = .008), as well as decreased bronchiolitis obliterans (BOS)-free survival at 1 (HR 1.87 [1.02, 3.41] P-value = .042) and 3 years (HR 2.15 [1.33, 3.5], P-value = .002).Conclusion: Post-transplant tracheostomy is a marker for advanced lung allograft dysfunction with significant reduction in long-term overall and BOS-free survival.

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“…5,6 Therefore, it was the aim of our study to assess the safety and efficacy of PDT in lung and heart transplant recipients experiencing prolonged ventilation.…”

Section: Introductionmentioning

confidence: 99%

Safety and Efficiency of Percutaneous Dilatational Tracheostomy With Direct Bronchoscopic Guidance for Thoracic Transplant Recipients

et al. 2016

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BACKGROUND: Percutaneous dilatational tracheostomy (PDT) is the standard airway access in critically ill patients who require prolonged mechanical ventilation. However, the literature lacks reports about the effectiveness and safety of this procedure in thoracic organ transplant recipients, who have increased risks of bleeding and infection. METHODS: We retrospectively reviewed the records of subjects who underwent thoracic organ transplantation at our institution between January 2004 and March 2011 followed by PDT (using the Ciaglia Blue Rhino technique with direct bronchoscopic guidance). RESULTS: From a total of 312 thoracic transplant recipients, we identified 93 (29.8%) subjects with PDT. Of these, 79 had undergone double lung transplant, 11 had undergone heart transplant, 2 had undergone combined heart-lung transplant, and 1 had undergone combined heart-kidney transplant. Mean age was 49.5 ؎ 11.2 y, and 58% of subjects were female. The mean time from intubation to PDT was 3.7 ؎ 3.4 d, and mean time from transplant to PDT was 12.6 ؎ 28.3 d. Thirty-two subjects (34.4%) underwent PDT after re-intubation. Thirtynine subjects were receiving renal replacement therapy (41.9%), and 28 had a coagulopathy (30.1%). Moderate but not significant bleeding was observed in 3 subjects. There were no major complications during PDT procedures. Forty-five subjects (48.4%) could be weaned successfully from the ventilator and the tracheostoma could be removed. Forty-eight subjects (51.6%) died due to sepsis, multi-organ failure, or transplant failure. No procedure-related deaths were noted. There were no significant late complications. Among the 45 who survived their stay in the ICU, the functional and cosmetic outcomes of PDT were excellent. CONCLUSIONS: PDT can be safely performed on patients with acute respiratory failure after thoracic organ transplantation. Therefore, we recommend the use of this technique for prolonged airway management in these patients.

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Early Tracheostomy Following Lung Transplantation

Cited by 26 publications

References 11 publications

Mechanical ventilation for the lung transplant recipient

Mechanical ventilation for the lung transplant recipient

Need for tracheostomy after lung transplant predicts decreased mid‐ and long‐term survival

Safety and Efficiency of Percutaneous Dilatational Tracheostomy With Direct Bronchoscopic Guidance for Thoracic Transplant Recipients

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