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

Atchade, Enora; Boughaba, Aimane; Dinh, Alexy Tran; Jean-Baptiste, Sylvain; Tanaka, Sébastien; Copelovici, Léa; Lortat-Jacob, Brice; Roussel, Arnaud; Castier, Yves; Messika, Jonathan; Mal, Hervé; Tymowski, Christian de; Montravers, Philippe

doi:10.3389/fmed.2023.1160621

Cited by 8 publications

(4 citation statements)

References 33 publications

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“…19,20 The difficulty for clinicians is to identify which patients are suitable for early extubation after undergoing LTx. 21 In our study, postoperative MV time was significantly greater in the high DP group compared with the low DP group. Therefore, ᭝P might help identify patients who would wean successfully away from MV as early as possible after LTx.…”

Section: Discussionsupporting

confidence: 43%

Driving pressure association with mortality in post-lung transplant patients: A prospective observational study

Xuan,

Gu,

Chen

et al. 2024

J Int Med Res

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Objective To investigate the association between driving pressure (ΔP) and 90-day mortality in patients following lung transplantation (LTx) in patients who developed primary graft dysfunction (PGD). Methods This prospective, observational study involved consecutive patients who, following LTx, were admitted to our intensive care unit (ICU) from January 2022 to January 2023. Patients were separated into two groups according to ΔP at time of admission (i.e., low, ≤15 cmH2O or high, >15 cmH2O). Postoperative outcomes were compared between groups. Results In total, 104 patients were involved in the study, and of these, 69 were included in the low ΔP group and 35 in the high ΔP group. Kaplan-Meier analysis of 90-day mortality showed a statistically significant difference between groups with survival better in the low ΔP group compared with the high ΔP group. According to Cox proportional regression model, the variables independently associated with 90-day mortality were ΔP and pneumonia. Significantly more patients in the high ΔP group than the low ΔP group had PGD grade 3 (PGD3), pneumonia, required tracheostomy, and had prolonged postoperative extracorporeal membrane oxygenation (ECMO) time, postoperative ventilator time, and ICU stay. Conclusions Driving pressure appears to have the ability to predict PGD3 and 90-day mortality of patients following LTx. Further studies are required to confirm our results.

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Section: Discussionsupporting

confidence: 43%

Driving pressure association with mortality in post-lung transplant patients: A prospective observational study

Xuan,

Gu,

Chen

et al. 2024

J Int Med Res

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“…A few studies have examined PMV after lung transplantation, reporting frequencies of 5%–28% with a wide range of definitions ranging from 72 h to 60 days [ 4 , 5 , 28 , 29 ]. Previous reports showed higher re-intubation and tracheostomy rates among PMV patients, translating into longer ICU lengths of stay [ 30 , 31 ] and matching our results.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation

Ghiani,

Kneidinger,

Neurohr

et al. 2023

Transpl Int

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Prolonged mechanical ventilation (PMV) after lung transplantation poses several risks, including higher tracheostomy rates and increased in-hospital mortality. Mechanical power (MP) of artificial ventilation unifies the ventilatory variables that determine gas exchange and may be related to allograft function following transplant, affecting ventilator weaning. We retrospectively analyzed consecutive double lung transplant recipients at a national transplant center, ventilated through endotracheal tubes upon ICU admission, excluding those receiving extracorporeal support. MP and derived indexes assessed up to 36 h after transplant were correlated with invasive ventilation duration using Spearman’s coefficient, and we conducted receiver operating characteristic (ROC) curve analysis to evaluate the accuracy in predicting PMV (>72 h), expressed as area under the ROC curve (AUROC). PMV occurred in 82 (35%) out of 237 cases. MP was significantly correlated with invasive ventilation duration (Spearman’s ρ = 0.252 [95% CI 0.129–0.369], p < 0.01), with power density (MP normalized to lung-thorax compliance) demonstrating the strongest correlation (ρ = 0.452 [0.345–0.548], p < 0.01) and enhancing PMV prediction (AUROC 0.78 [95% CI 0.72–0.83], p < 0.01) compared to MP (AUROC 0.66 [0.60–0.72], p < 0.01). Mechanical power density may help identify patients at risk for PMV after double lung transplantation.

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“…The impact of PMV in LTx has been previously assessed retrospectively in the literature; the incidence of PMV was 29%, the post-operative complications of patients (primary graft dysfunction (PGD), infections, acute kidney injury, etc.) increased, the mortality rates of these patients were high, approximately 22% at 90-day and 44% at 1-year 3 . Due to the heterogeneity of LTx itself, the factors affecting PMV are complex, and they are divided into three aspects: pre-operative, intra-operative, and post-operative.…”

Section: Introductionmentioning

confidence: 94%

A novel nomogram for predicting prolonged mechanical ventilation in lung transplantation patients using extracorporeal membrane oxygenation

Xuan,

Gu,

et al. 2024

Sci Rep

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Prolonged mechanical ventilation (PMV) is commonly associated with increased post-operative complications and mortality. Nevertheless, the predictive factors of PMV after lung transplantation (LTx) using extracorporeal membrane oxygenation (ECMO) as a bridge remain unclear. The present study aimed to develop a novel nomogram for PMV prediction in patients using ECMO as a bridge to LTx. A total of 173 patients who used ECMO as a bridge following LTx from January 2022 to June 2023 were divided into the training (122) and validation sets (52). A mechanical ventilation density plot of patients after LTx was then performed. The training set was divided in two groups, namely PMV (95) and non-prolonged ventilation (NPMV) (27). For the survival analysis, the effect of PMV was assessed using the log-rank test. Univariate and multivariate logistic regression analyses were performed to assess factors associated with PMV. A risk nomogram was established based on the multivariate analysis, and model performance was further assessed in terms of calibration, discrimination, and clinical usefulness. Internal validation was additionally conducted. The difference in survival curves in PMV and NPMV groups was statistically significant (P < 0.001). The multivariate analysis and risk factors in the nomogram revealed four factors to be significantly associated with PMV, namely the body mass index (BMI), operation time, lactic acid at T0 (Lac), and driving pressure (DP) at T0. These four factors were used to develop a nomogram, with an area under the curve (AUC) of 0.852 and good calibration. After internal validation, AUC was 0.789 with good calibration. Furthermore, goodness-of-fit test and decision-curve analysis (DCA) indicated satisfactory performance in the training and internal validation sets. The proposed nomogram can reliably and accurately predict the risk of patients to develop PMV after LTx using ECMO as a bridge. Four modifiable factors including BMI, operation time, Lac, and DP were optimized, which may guide preventative measures and improve prognosis.

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

Cited by 8 publications

References 33 publications

Driving pressure association with mortality in post-lung transplant patients: A prospective observational study

Driving pressure association with mortality in post-lung transplant patients: A prospective observational study

Mechanical Power Density Predicts Prolonged Ventilation Following Double Lung Transplantation

A novel nomogram for predicting prolonged mechanical ventilation in lung transplantation patients using extracorporeal membrane oxygenation

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