Komurcu Ozgur, Ozdemirkan Aycan, Camkiran Firat Aynur, Zeyneloglu Pinar, Sezgin Atilla, Pirat Arash
From Baskent University, School of Medicine, Department of Anesthesiology and Critical Care Medicine, Ankara, Turkey.
Exp Clin Transplant. 2015 Nov;13 Suppl 3:22-5. doi: 10.6002/ect.tdtd2015.O14.
This study sought to evaluate the incidence, risk factors, and outcomes of acute respiratory failure in cardiac transplant recipients.
Cardiac transplant recipients >15 years of age and readmitted to the intensive care unit after cardiac transplant between 2005 and 2015 were included.
Thirty-nine patients were included in the final analyses. Patients with acute respiratory failure and without acute respiratory failure were compared. The most frequent causes of readmission were routine intensive care unit follow-up after endomyocardial biopsy, heart failure, sepsis, and pneumonia. Patients who were readmitted to the intensive care unit were further divided into 2 groups based on presence of acute respiratory failure. Patients' ages and body weights did not differ between groups. The groups were not different in terms of comorbidities. The admission sequential organ failure assessment scores were higher in patients with acute respiratory failure. Patients with acute respiratory failure were more likely to use bronchodilators and n-acetylcysteine before readmission. Mean peak inspiratory pressures were higher in patients in acute respiratory failure. Patients with acute respiratory failure developed sepsis more frequently and they were more likely to have hypotension. Patients with acute respiratory failure had higher values of serum creatinine before admission to intensive care unit and in the first day of intensive care unit. Patients with acute respiratory failure had more frequent bilateral opacities on chest radiographs and positive blood and urine cultures. Duration of intensive care unit and hospital stays were not statistically different between groups. Mortality in patients with acute respiratory failure was 76.5% compared with 0% in patients without acute respiratory failure.
A significant number of cardiac transplant recipients were readmitted to the intensive care unit. Patients presenting with acute respiratory failure on readmission more frequently developed sepsis and hypotension, suggesting a poorer prognosis.
本研究旨在评估心脏移植受者急性呼吸衰竭的发生率、危险因素及预后。
纳入2005年至2015年间年龄大于15岁且心脏移植后再次入住重症监护病房的心脏移植受者。
最终分析纳入39例患者。对发生急性呼吸衰竭和未发生急性呼吸衰竭的患者进行了比较。再次入院最常见的原因是心内膜心肌活检后的常规重症监护病房随访、心力衰竭、败血症和肺炎。根据是否存在急性呼吸衰竭，将再次入住重症监护病房的患者进一步分为两组。两组患者的年龄和体重无差异。两组在合并症方面无差异。急性呼吸衰竭患者的入院序贯器官衰竭评估评分更高。发生急性呼吸衰竭的患者在再次入院前更有可能使用支气管扩张剂和N-乙酰半胱氨酸。急性呼吸衰竭患者的平均吸气峰压更高。急性呼吸衰竭患者更频繁地发生败血症，且更有可能出现低血压。急性呼吸衰竭患者在入住重症监护病房前及入住重症监护病房第一天的血清肌酐值更高。急性呼吸衰竭患者胸部X线片上双侧模糊影更常见，血培养和尿培养阳性。两组患者在重症监护病房和住院时间上无统计学差异。急性呼吸衰竭患者的死亡率为76.5%，而未发生急性呼吸衰竭的患者死亡率为0%。
相当数量的心脏移植受者再次入住重症监护病房。再次入院时出现急性呼吸衰竭的患者更频繁地发生败血症和低血压，提示预后较差。
