Operating room extubation: A predictive factor for 1-year survival after double-lung transplantation
Graphical abstract
Section snippets
Methods
The Institutional Review Board of the French Society for Anesthesia and Intensive Care approved the analysis of this prospectively maintained institutional anesthesia lung transplant database (CERAR N°IRB 00010254 – 2019; June 29, 2019). Informed consent was obtained from all patients. The Foch Lung Transplant Group attests strict compliance with the International Society for Heart and Lung Transplantation ethics statement.
Results
A total of 475 patients underwent DLT at our institution during the study period. After excluding patients who did not meet the study criteria, 450 patients were included in the analysis; among them, 161 (35.8%) were extubated in the OR (Figure 1). All organs were obtained from brain-dead donors, regardless of the etiology, except 22 organs that were donated after circulatory death.
Discussion
This retrospective single-center study showed that OR extubation i) was possible for nearly one-third of patients undergoing DLT; ii) was safe; and iii) was a clinical marker of a good prognosis, as the outcomes were better in these patients than in patients extubated in the ICU. Of prime importance was that our protocol did not include the preselection of potential patients for OR extubation and considered that all patients were candidates for OR extubation and that the decision was made at
Limitations of the study
First, our study was subject to all inherent limitations of any retrospective single-center analysis. However, all the data were prospectively collected from an institutional database with strict definitions. It would be interesting to randomize patients likely requiring extubation in the OR into 2 groups: an OR extubation group and an ICU extubation group, but it seems unethical to us to continue ventilation (and sedation) if it is not necessary. Second, our study focused exclusively on
Conclusion
In conclusion, OR extubation after DLT is an option for COPD/emphysema patients (51.3% of extubated patients were in this group) and cystic fibrosis patients (36.3%) but probably should not be pursued in patients with interstitial lung disease (14.3%). The survival of patients who underwent OR extubation was higher at all time points. Moreover, OR-extubated patients suffered fewer postoperative complications, including PGD3, than ICU-extubated patients. OR extubation could be considered as a
Disclosure statement
The authors have no conflicts of interest pertinent to the paper to disclose.
This study was supported by Hospital Foch, 40 rue Worth, Suresnes, France. The sponsor played no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
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