BACKGROUND: The development of severe primary graft dysfunction (PGD) is a risk factor for perioperative death following lung transplantation. Our goal is to improve the predictive value of the earliest Pao(2)/fraction of inspired oxygen (P/F) measurements that gauge PGD severity. METHODS: We identified 96 patients with severe PGD (P/F < 200) at ICU arrival through a retrospective review of 431 lung transplants performed at our institution from 1992 to 2005. The P/F trend, represented as quartiles of the 12-h percentage change in P/F, was analyzed using multivariate logistic regression. Study outcomes were 90-day death and long-term survival. RESULTS: The median percentage change in P/F over 12 h was + 52% (interquartile range, +20 to 90%). We observed the highest early mortality among those in the lowest quartile of the P/F trend (an increase in P/F <or= 20%). Ninety-day death rates decreased across the quartiles (low quartile, 32%; low-mid quartile, 9%; high-mid quartile, 5%; high quartile, 5%; test for trend, p = 0.007). After adjustment for the use of cardiopulmonary bypass, those in the lowest quartile of P/F trend had 6.8 times the odds of early death vs patients with a more favorable trend (odds ratio, 6.80; 95% confidence interval, 1.73 to 0.51; p = 0.007). In the first 5 years after transplant, there were significantly more deaths within the low quartile group vs those with a more rapidly increasing P/F trend (log-rank test, p = 0.01). CONCLUSIONS: Among lung recipients with severe PGD at ICU arrival, an improvement in P/F <or= 20% in the first 12 h portends a poor outcome.
BACKGROUND: The development of severe primary graft dysfunction (PGD) is a risk factor for perioperative death following lung transplantation. Our goal is to improve the predictive value of the earliest Pao(2)/fraction of inspired oxygen (P/F) measurements that gauge PGD severity. METHODS: We identified 96 patients with severe PGD (P/F < 200) at ICU arrival through a retrospective review of 431 lung transplants performed at our institution from 1992 to 2005. The P/F trend, represented as quartiles of the 12-h percentage change in P/F, was analyzed using multivariate logistic regression. Study outcomes were 90-day death and long-term survival. RESULTS: The median percentage change in P/F over 12 h was + 52% (interquartile range, +20 to 90%). We observed the highest early mortality among those in the lowest quartile of the P/F trend (an increase in P/F <or= 20%). Ninety-day death rates decreased across the quartiles (low quartile, 32%; low-mid quartile, 9%; high-mid quartile, 5%; high quartile, 5%; test for trend, p = 0.007). After adjustment for the use of cardiopulmonary bypass, those in the lowest quartile of P/F trend had 6.8 times the odds of early death vs patients with a more favorable trend (odds ratio, 6.80; 95% confidence interval, 1.73 to 0.51; p = 0.007). In the first 5 years after transplant, there were significantly more deaths within the low quartile group vs those with a more rapidly increasing P/F trend (log-rank test, p = 0.01). CONCLUSIONS: Among lung recipients with severe PGD at ICU arrival, an improvement in P/F <or= 20% in the first 12 h portends a poor outcome.
Authors: Ali M Farooki; Heidi Bazick-Cuschieri; Emily K Gordon; James C Lee; Edward C Cantu; John G Augoustides Journal: J Cardiothorac Vasc Anesth Date: 2013-08-30 Impact factor: 2.628
Authors: Jason D Christie; Scarlett Bellamy; Lorraine B Ware; David Lederer; Denis Hadjiliadis; James Lee; Nancy Robinson; A Russell Localio; Keith Wille; Vibha Lama; Scott Palmer; Jonathan Orens; Ann Weinacker; Maria Crespo; Ejigaehu Demissie; Stephen E Kimmel; Steven M Kawut Journal: J Heart Lung Transplant Date: 2010-07-22 Impact factor: 10.247
Authors: Edward Cantu; Joshua M Diamond; Yoshikazu Suzuki; Jared Lasky; Christian Schaufler; Brian Lim; Rupal Shah; Mary Porteous; David J Lederer; Steven M Kawut; Scott M Palmer; Laurie D Snyder; Matthew G Hartwig; Vibha N Lama; Sangeeta Bhorade; Christian Bermudez; Maria Crespo; John McDyer; Keith Wille; Jonathan Orens; Pali D Shah; Ann Weinacker; David Weill; David Wilkes; David Roe; Chadi Hage; Lorraine B Ware; Scarlett L Bellamy; Jason D Christie Journal: Am J Respir Crit Care Med Date: 2018-01-15 Impact factor: 30.528