Lung protective ventilation based on donor size is associated with a lower risk of severe primary graft dysfunction after lung transplantation.
Lung protective ventilation based on donor size is associated with a lower risk of severe primary graft dysfunction after lung transplantation.
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DOI：
10.1016/j.healun.2021.06.016
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发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Hachem RR
中科院分区：
文献类型：
--
作者：
Tague LK;Bedair B;Witt C;Byers DE;Vazquez-Guillamet R;Kulkarni H;Alexander-Brett J;Nava R;Puri V;Kreisel D;Trulock EP;Gelman A;Hachem RR
肺移植后立即进行机械通气可能会影响原发性移植物功能障碍（PGD）的发展，特别是在供体-受体尺寸不匹配的情况下，因为通气通常基于受体而不是供体尺寸。我们于 2010 年 1 月至 2017 年 1 月期间对我们中心的成人双侧肺移植受者进行了回顾性队列研究。我们将基于供体的肺保护性通气 (dLPV) 定义为供体理想体重 6 至 8 ml/kg，平台压 <30 cm H2O。我们计算了供体-受体预测的总肺活量 (pTLC) 比率，并使用逻辑回归来检查 pTLC 比率、dLPV 和 48 至 72 小时的 PGD 3 级之间的关系。我们使用 Cox 比例风险模型来检查 pTLC 比率、dLPV 和 1 年生存率之间的关系。该队列包括 373 名接受者； 24 名 (6.4%) 在 48 至 72 小时内进行了 PGD 3 级，213 名 (57.3%) 接受了 dLPV。平均 pTLC 比率为 1.04 ± 0.18。 dLPV 与显着降低的 3 级 PGD 风险（OR = 0.44；95% CI：0.29–0.68，p < 0.001）和 1 年死亡率（HR = 0.49；95% CI：0.29–0.8，p = 0.018）相关。 pTLC 比率与 3 级 PGD 风险之间存在显着相关性，但使用 dLPV 减弱了这种相关性。 dLPV 与 48 至 72 小时内 3 级 PGD 风险降低以及 1 年死亡率降低相关。此外，dLPV 减弱了 pTLC 与 PGD 3 级和 1 年死亡率之间的关联。基于供体的通气策略可能有助于降低 PGD 的风险以及肺移植后与尺寸不匹配相关的其他不良后果。
Mechanical ventilation immediately after lung transplantation may impact the development of primary graft dysfunction (PGD), particularly in cases of donor-recipient size mismatch as ventilation is typically based on recipient rather than donor size. We conducted a retrospective cohort study of adult bilateral lung transplant recipients at our center between January 2010 and January 2017. We defined donor-based lung protective ventilation (dLPV) as 6 to 8 ml/kg of donor ideal body weight and plateau pressure <30 cm H2O. We calculated the donor-recipient predicted total lung capacity (pTLC) ratio and used logistic regression to examine relationships between pTLC ratio, dLPV and PGD grade 3 at 48 to 72 hours. We used Cox proportional hazards modelling to examine the relationship between pTLC ratio, dLPV and 1-year survival. The cohort included 373 recipients; 24 (6.4%) developed PGD grade 3 at 48 to 72 hours, and 213 (57.3%) received dLPV. Mean pTLC ratio was 1.04 ± 0.18. dLPV was associated with significantly lower risks of PGD grade 3 (OR = 0.44; 95% CI: 0.29–0.68, p < 0.001) and 1-year mortality (HR = 0.49; 95% CI: 0.29–0.8, p = 0.018). There was a significant association between pTLC ratio and the risk of PGD grade 3, but this was attenuated by the use of dLPV. dLPV is associated with decreased risk of PGD grade 3 at 48 to 72 hours and decreased 1-year mortality. Additionally, dLPV attenuates the association between pTLC and both PGD grade 3 and 1-year mortality. Donor-based ventilation strategies may help to mitigate the risk of PGD and other adverse outcomes associated with size mismatch after lung transplantation.
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DOI：
10.1186/cc8230
发表时间：
2010
期刊：
Critical care (London, England)
影响因子：
--
作者：
Determann RM;Royakkers A;Wolthuis EK;Vlaar AP;Choi G;Paulus F;Hofstra JJ;de Graaff MJ;Korevaar JC;Schultz MJ
通讯作者：
Schultz MJ
影响因子：
5.7
作者：
Lee, James C.;Christie, Jason D.
通讯作者：
Christie, Jason D.
影响因子：
8.9
作者：
Chambers, Daniel C.;Cherikh, Wida S.;Stehlik, Josef
通讯作者：
Stehlik, Josef
影响因子：
8.9
作者：
Christie, Jason D.;Bellamy, Scarlett;Kawut, Steven M.
通讯作者：
Kawut, Steven M.
DOI：
10.1164/rccm.200409-1243oc
发表时间：
2005-06-01
影响因子：
24.7
作者：
Christie, JD;Kotloff, RM;Kimmel, SE
通讯作者：
Kimmel, SE