Lung transplant recipients (LTR) may develop respiratory failure in the post transplant period requiring prolonged mechanical ventilation (PMV). Factors contributing to respiratory failure, PMV associated complications, and long term outcomes and survival have never been reported in this unique population.
Charts of LTR who required a tracheostomy for respiratory failure during the post transplant period were reviewed for demographics, extubation history, duration and complications of PMV, discharge disposition, and survival.
Of 304 identified adult LTR during a 12-year period, 17 (5%) patients [age(yrs ± SD): 51.5 ± 14.6, 11 females] received tracheostomies for PMV and weaning. Ten patients were extubated at least once prior to tracheostomy placement. The most common reasons for failure to wean were nosocomial pneumonia (n=10), excessive secretions and mucus plugging (n=7), and the graft failure or reperfusion injury (n=6). The median duration of mechanical ventilatory support was 62 days (interquartile range, 21 to 210 days). Complications as a result of PMV included: 1) ventilator associated pneumonia (38%), 2) sepsis or bacteremia (19%), and 3) renal insufficiency (13%). Ten patients were weaned and decannulated from PMV. Seven patients never achieved ventilator independence. Eleven LTR died and the median period of survival from time of trancheostomy placement to time of death was 21.8 weeks (interquartile range, 0.3 to 123 weeks). The majority of patients (n=5) died within the first month of transplantation, 2 patients within 3 months post transplant, 3 patients within the first year post transplantation, and only 1 patient survived past one year. The most common causes of death were pneumonia (n=6) and sepsis (n=6). Only 1 patient had evidence of graft rejection at the time of death.CONCLUSIONS: PMV in LTR is associated with significant mortality and morbidity. Ventilator associated pneumonia is a significant contributor to the development of respiratory failure leading to tracheostomy and PMV.
Early respiratory failure and eventual tracheostomy represent a significant risk factor for early mortality in LTR.
M.M. Budev, None.