title: Prolonged Mechanical Ventilation After Lung Transplantation-A Single-Center Study.
abstract: This single-center study examines the incidence, etiology, and outcomes associated with prolonged mechanical ventilation (PMV), defined as time to definite spontaneous ventilation >21 days after double lung transplantation (LTx). A total of 690 LTx recipients between January 2005 and December 2012 were analyzed. PMV was necessary in 95 (13.8%) patients with decreasing incidence during the observation period (p < 0.001). Independent predictors of PMV were renal replacement therapy (odds ratio [OR] 11.13 [95% CI, 5.82-21.29], p < 0.001), anastomotic dehiscence (OR 8.74 [95% CI 2.42-31.58], p = 0.001), autoimmune comorbidity (OR 5.52 [95% CI 1.86-16.41], p = 0.002), and postoperative neurologic complications (OR 5.03 [95% CI 1.98-12.81], p = 0.001), among others. Overall 1-year survival was 86.0% (90.4% for LTx between 2010 and 2012); it was 60.7% after PMV and 90.0% in controls (p < 0.001). Conditional long-term outcome among hospital survivors, however, did not differ between the groups (p = 0.78). Multivariate analysis identified renal replacement therapy (hazard ratio [HR] 3.55 [95% CI 2.40-5.25], p < 0.001), post-LTx extracorporeal membrane oxygenation (HR 3.47 [95% CI 2.06-5.83], p < 0.001), and prolonged inotropic support (HR 1.95 [95% CI 1.39-2.75], p < 0.001), among others, as independent predictors of mortality. In conclusion, PMV complicated 14% of LTx procedures and, although associated with increased in-hospital mortality, outcomes among patients surviving to hospital discharge were unaffected.
authors.affiliation: Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Hadem
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.|German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Gottlieb
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Seifert
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Fegbeutel
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.|German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Sommer
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Greer
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Wiesner
authors.affiliation: Department of Nephrology and Hypertensiology, Hannover Medical School, Hannover, Germany.
authors.forename: J T
authors.initials: JT
authors.lastname: Kielstein
authors.affiliation: Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany.
authors.forename: A S
authors.initials: AS
authors.lastname: Schneider
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Ius
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.|German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Fuge
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.|German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kühn
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Tudorache
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.|German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.|German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Welte
authors.affiliation: Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.|German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Warnecke
authors.affiliation: Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.|German Centre of Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany.
authors.forename: M M
authors.initials: MM
authors.lastname: Hoeper
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000150:complications / Q000401:mortality* / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D011379:Prognosis; D012121:Respiration, Artificial / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors