Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Lung. 2022 Feb;200(1):5-10. doi: 10.1007/s00408-021-00508-9. Epub 2022 Jan 10.
There are limited data regarding hospital and intensive care unit (ICU) outcomes in patients with hepatopulmonary syndrome (HPS) following liver transplantation (LT).
Data were retrospectively collected from consecutive HPS adult patients who underwent LT and were immediately admitted to the ICU at three transplant centers with shared management protocols, from 2002 to 2018. Demographic, clinical, surgical, laboratory, and outcome data were extracted.
We identified 137 patients (74 male, 54%), with a median age at LT of 58 years (IQR: 52-63). One hundred and 31 (95.6%) patients were admitted to the ICU on invasive mechanical ventilation (MV). The median time on invasive MV in the ICU was 12 hours (IQR: 5-28) and 97 patients (74%) were extubated within 24 hours of ICU admission. The median highest positive end expiratory pressure and fraction of inspired oxygen (FiO) were 7 (IQR: 5-8) and 0.6 (IQR: 0.5-0.7), respectively. 7 patients (5%) developed severe post-transplant hypoxemia. Of all patients, 42 (30.4%) required vasopressors and the median ICU and hospital length of stay (LOS) were 3 (IQR: 1-5) and 10 (IQR: 7-20) days, respectively. The in-hospital mortality rate was 3.6% (5/137). HPS severity was not associated with hospital mortality.
Most HPS patients have short durations of MV, ICU, and hospital LOS post-LT. HPS severity does not impact hospital mortality.
在肝移植（LT）后，有关肝肺综合征（HPS）患者的医院和重症监护病房（ICU）结局的数据有限。
本研究回顾性收集了 2002 年至 2018 年期间在三个具有共享管理方案的移植中心接受 LT 并立即入住 ICU 的连续 HPS 成年患者的数据。提取了人口统计学、临床、手术、实验室和结果数据。
共确定了 137 名患者（74 名男性，54％），LT 时的中位年龄为 58 岁（IQR：52-63）。131 名（95.6％）患者在 ICU 接受有创机械通气（MV）。在 ICU 上有创 MV 的中位时间为 12 小时（IQR：5-28），97 名（74％）患者在 ICU 入住后 24 小时内拔管。中位最高呼气末正压和吸入氧分数（FiO）分别为 7（IQR：5-8）和 0.6（IQR：0.5-0.7）。7 名患者（5％）发生严重移植后低氧血症。所有患者中有 42 名（30.4％）需要升压药，ICU 和住院时间的中位数分别为 3（IQR：1-5）和 10（IQR：7-20）天。院内死亡率为 3.6％（5/137）。HPS 严重程度与医院死亡率无关。
大多数 HPS 患者在 LT 后 MV、ICU 和住院时间较短。HPS 严重程度不影响医院死亡率。
