title: Immediate postoperative extubation in bilateral lung transplantation: predictive factors and outcomes.
abstract: BACKGROUND
  We reviewed our experience with tracheal extubation in the operating room (E-OR) among cystic fibrosis patients requiring bilateral lung transplantation to evaluate safety and determine predictive factors of E-OR.
  
  
  METHODS
  The charts of 89 recipients (from May 2007 to June 2013) were analysed. Patients were divided into E-OR and E-ICU (intensive care unit extubation) groups. Data are expressed as numbers (percentages) or medians [25th-75th percentiles].
  
  
  RESULTS
  There were 41 patients in the E-OR group (46%). Donor and recipient characteristics were similar between groups. Intraoperative complications occurred less frequently in the E-OR group, and fluid and transfusion requirements were lower. Postoperative courses were different in the E-OR group, including a lower rate of grade 3 primary graft dysfunction (0 compared with 19 patients, P<0.0001) and shorter ICU (5.0 [3.7-7.2] compared with 11.5 [7.0-15.5] days) and hospital stays (22.0 [18.0-25.5] compared with 33.0 [25.0-56.5] days, respectively; P<0.0001 for both). The 1 yr survival rates were similar: 95% in the E-OR group and 98% in the E-ICU group. A statistical model built on a development cohort of 60 randomly selected patients predicted 95% of E-OR instances in this cohort and 82% of E-OR instances in the validation cohort (28 patients). Predictive factors were complications during single-lung ventilation (second graft implantation), complications during bipulmonary ventilation (end of surgery), and the ratio of arterial partial pressure of oxygen to fractional inspired oxygen (end of surgery).
  
  
  CONCLUSIONS
  Our protocol allowed for extubation of 46% of bilateral lung transplant patients without increased postoperative risks.
authors.affiliation: Department of Anaesthesia University Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
authors.forename: M-L
authors.initials: ML
authors.lastname: Felten
authors.affiliation: Department of Anaesthesia University Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
authors.forename: J-D
authors.initials: JD
authors.lastname: Moyer
authors.affiliation: Department of Clinical Research and Innovation.
authors.forename: J-F
authors.initials: JF
authors.lastname: Dreyfus
authors.affiliation: Department of Anaesthesia University Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Marandon
authors.affiliation: Department of Thoracic Surgery University Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
authors.forename: E
authors.initials: E
authors.lastname: Sage
authors.affiliation: Department of Pneumology University Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
authors.forename: A
authors.initials: A
authors.lastname: Roux
authors.affiliation: Department of Thoracic Surgery University Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
authors.forename: F
authors.initials: F
authors.lastname: Parquin
authors.affiliation: Department of Intensive Care, Foch Hospital, 92150 Suresnes, France.
authors.forename: C
authors.initials: C
authors.lastname: Cerf
authors.affiliation: Department of Intensive Care, Versailles Hospital, 78150 Le Chesnay, France.
authors.forename: B
authors.initials: B
authors.lastname: Zuber
authors.affiliation: Department of Anaesthesia University Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France.
authors.forename: M
authors.initials: M
authors.lastname: Le Guen
authors.affiliation: Department of Anaesthesia University Versailles-Saint-Quentin-en-Yvelines, 78000 Versailles, France m.fischler@hopital-foch.org.
authors.forename: M
authors.initials: M
authors.lastname: Fischler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D060666:Airway Extubation / Q000379:methods*; D062186:Arterial Pressure; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D003422:Critical Care; D003550:Cystic Fibrosis / Q000601:surgery; D005260:Female; D006801:Humans; D007902:Length of Stay; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061810:One-Lung Ventilation; D009873:Operating Rooms; D010100:Oxygen / Q000097:blood; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010100:Oxygen
keywords: anaesthesia; lung transplantation