Chest
Clinical Investigations in Critical CareLung Transplantation After Long-term Mechanical Ventilation: Results and 1-Year Follow-up
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
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Cited by (45)
Long-term outcome and bridging success of patients evaluated and bridged to lung transplantation on the ICU
2022, Journal of Heart and Lung TransplantationCitation Excerpt :The 1 year survival of 87% in this study was comparable to international outcomes,1 and was similar in patients bridged to LTx and in patients evaluated and bridged to LTx on the ICU. Initial 1 year survival rates of patients bridged to LTx were inferior to non-bridged patients, an analysis performed between 1987 and 2008 in UNOS (United Network for Organ Sharing database) showed a 1- survival of 62% for patients on MV and 50% on ECMO.7,13 The 1 year survival improved over time ranging from 57.6% to 93%.14
ICU Care Before and After Lung Transplantation
2016, ChestCitation Excerpt :Case series and small, retrospective single-center analysis from the 1990s have shown varying results of bridging end-stage lung diseases to LTx by MV.7-10 Publications have reported a 1-year survival between 25% and 87% in this setting.10-14 In these studies, candidates on MV represented a heterogeneous cohort, varying from awake, even mobilized patients on long-term ventilation to profoundly sedated intubated patients with high-airway pressures.
Current Status of Lung Transplantation
2014, Regenerative Medicine Applications in Organ TransplantationOutcomes and temporal trends among high-risk patients after lung transplantation in the United States
2012, Journal of Heart and Lung TransplantationCitation Excerpt :Historically, the need for ventilator or ECMO support has been considered a contraindication to LTx.5,6 Ventilator support before LTx is thought to increase the risk of microbial airway colonization and lead to respiratory muscle deconditioning, resulting in increased post-LTx ventilation time and pneumonia.7,8 Thus, many patients are removed from the transplant waiting list if they require intubation.8
The impact of pretransplant mechanical ventilation on short- and long-term survival after lung transplantation
2011, American Journal of TransplantationLung Transplant
2011, Critical Care Nursing Clinics of North America