Chest
Volume 119, Issue 1, January 2001, Pages 224-227
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Clinical Investigations in Critical Care
Lung Transplantation After Long-term Mechanical Ventilation: Results and 1-Year Follow-up

https://doi.org/10.1378/chest.119.1.224Get rights and content

Background:

Long-term mechanical ventilation isconsidered as a relative or absolute contraindication for lungtransplantation by most centers. We report on the results oftransplantation in nine patients requiring long-term mechanicalventilation at two lung transplant centers.

Methods:

The study group (group 1) consisted of nine patients receivingmechanical ventilation who underwent lung transplantation at either, Duke University Medical Center or the University of Florida between1992 and 1997. Patients in group 1 met the following criteria: theyunderwent exercise therapy with a physical therapist, and they werewithout panresistant bacterial airway colonization. The study patientsthat met these criteria spent at least 13 days receiving mechanicalventilation prior to transplantation. The control population (group 2;n = 65) consisted of all patients who underwent transplantation ateither center in the calendar year 1997 who were ventilatorindependent. The 1-year survival rates in each group were calculated bythe Kaplan-Meier method. The number of days required for extubation ineach group were compared by the nonparametric Wilcoxon rank sum test. The FEV1 value at 1 year was reported in each group.

Results:

The 1-year survival rates were 78% and 83% ingroup 1 and group 2, respectively. The mean number of days requireduntil extubation were 41 days in group 1 and 9 days in group 2(p < 0.01). The allograft function was comparable in the two groupsat 1 year.

Conclusions:

In a select population ofventilator-dependent patients, the 1-year survival rate is comparableto the standard lung transplant population. However, theseventilator-dependent patients require a significantly longer time untilextubation than other transplantrecipients.

Section snippets

Materials and Methods

The study population (group 1) was limited to patients requiringmechanical ventilation prior to transplantation who met the followingcriteria: they were ambulatory, they underwent exercise therapy with aphysical therapist, and they were colonized with sensitive bacteria. Nine patients who received mechanical ventilation for at least 13 daysmet these criteria. Seven patients who underwent transplantation andhad received mechanical ventilation for < 12 days were excludedbecause they were all

Results

There were nine patients in group 1, of whom four patientsunderwent SLT and five patients underwent BLT (Table 1). There were 65 patients in group 2, ofwhom 44 patients underwent SLT and 21 patients underwent BLT (Table 1). Five of nine patients in group 1 were colonized with Paeruginosa (each patient had sensitivity to at least oneantibacterial agent) prior to transplantation. All patients in group 1were ambulatory while receiving mechanical ventilation, and wereactively participating in a

Discussion

Ventilator dependency is considered as a relative or absolutecontraindication to lung transplantation by most centers.4These patients have been historically excluded because of concernsregarding airway colonization and the possible risk of posttransplantpneumonia. Moreover, long-term immobility and bed rest associated withmechanical ventilation predisposes this population to severedeconditioning and delays recovery after transplantation. Approximately3% of lung transplant recipients in the

References (7)

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