Abstract
Background: Lung transplantation (LT) is considered for patients with advanced lung disease who failed to improve symptoms with medical interventions. In post-LT patients who develop respiratory failure requiring prolonged mechanical ventilation, early tracheostomy (ET) (<72 h) is performed to facilitate weaning from ventilation. This study evaluated the effect of ET by comparing the outcomes of LT patients receiving ET to those who did not receive tracheostomy (DNRT) in a cardiothoracic intensive care unit (CTICU) from an academic medical center.
Methods: A retrospective electronic health record review compared LT patients' outcomes with a matched sample of DNRT patients on age, gender, type of transplant, ECMO support (pre and post), and other concomitant surgeries. From January 2018 to December 2022, all LT recipients were considered. Data were collected on demographics (age, race, sex), single or double LT, and clinical outcomes. The primary outcomes were mechanical ventilator days, days to first oral intake, days to first ambulation, hospital and ICU length of stay (LOS), and primary graft dysfunction (PGD). Secondary outcomes were one-year and 30-day survival rates. Mean, SD, frequency, and percentage were used to describe the patient population. The outcomes of ET and DNRT groups were compared using independent t-tests and considered P < .05 to be significant. The Anesthesia and Perioperative Outcomes for ICU Patients IRB protocol supported the data extraction.
Results: Between January 2018 and December 2022, 436 patients underwent LT; 46 patients had tracheostomy within 72 h. After 1:1 matching, the total sample size was 35 pairs ET-DNRT. There was a statistically significant difference between ET and DNRT groups on ICU LOS (22.5 ± 20.1 vs. 6.6 ± 3.7), hospital LOS (33 ± 22.3 vs. 16.1 ± 9.4), ventilator days (20.2 ± 24.7 vs. 1.8 ± 11.8), days to first oral intake (23.8 ± 23.5 vs. 4.9 ± 4.8), days to first ambulation (5.6 ± 4.9 vs. 2.5 ( ± 3.3). PGD grades 0 and 1 were more frequent in DNRT (29) than in ET (21). PGD grades 2 and 3 were more frequent in ET (12) than in DNRT (6). One-year and 30-day survival rates were similar for ET and DNRT.
Conclusions: This single-center report provides insight into the impact of ET in post-LT patients. The outcomes showed ET in post-LT with PGD>1, consistent with the institution's practice. In addition, ET and DNTR groups showed similar survival rates; therefore, ET can be safely performed for high-risk LT patients to promote early liberation from mechanical ventilation.
Footnotes
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