title: Implementation of a management guideline aimed at minimizing the severity of primary graft dysfunction after lung transplant.
abstract: OBJECTIVE
  Primary graft dysfunction, a severe form of lung injury that occurs in the first 72 hours after lung transplant, is associated with morbidity and mortality. We sought to assess the impact of an evidence-based guideline as a protocol for respiratory and hemodynamic management.
  
  
  METHODS
  Preoperative and postoperative data for patients treated per the guideline (n = 56) were compared with those of a historical control group (n = 53). Patient data such as ratio of arterial Po(2) to inspired oxygen fraction, central venous pressure, cumulative fluid balance, vasopressor dose, and serum urea and creatinine were measured and documented at specific times. Primary outcome was severity of primary graft dysfunction within the first 72 hours.
  
  
  RESULTS
  Primary graft dysfunction grade was progressively lower in patients treated after introduction of the guideline (P = .01). Lower postoperative fluid balances (P = .01) and vasopressor doses (P = .007) were seen, with no associated renal dysfunction. There were no differences in duration of mechanical ventilation or mortality. Nonadherence to the guideline occurred in 10 cases (18%).
  
  
  CONCLUSIONS
  Implementation of an evidence-based guideline for managing respiratory and hemodynamic status is feasible and safe and was associated with reduction in severity of primary graft dysfunction. Further studies are required to determine whether such a guideline would lead to a consistent reduction in severity of primary graft dysfunction at other institutions. Creation of a protocol for postoperative care provides a template for further studies of novel therapies or management strategies for primary graft dysfunction.
authors.affiliation: Faculty of Health, Medicine, Nursing and Behavioural Sciences, Deakin University, 221 Burwood Hwy, Burwood 3125, Victoria, Australia. judy.currey@deakin.edu.au
authors.forename: Judy
authors.initials: J
authors.lastname: Currey
authors.forename: David V
authors.initials: DV
authors.lastname: Pilcher
authors.forename: Andrew
authors.initials: A
authors.lastname: Davies
authors.forename: Carlos
authors.initials: C
authors.lastname: Scheinkestel
authors.forename: Mari
authors.initials: M
authors.lastname: Botti
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
authors.forename: Greg
authors.initials: G
authors.lastname: Snell
mesh_terms: D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D055031:Primary Graft Dysfunction / Q000503:physiopathology*; D012720:Severity of Illness Index; D016896:Treatment Outcome