Cerier Emily J, Toyoda Takahide, McNulty Colleen, O'Boye Anne, Kurihara Chitaru, Bharat Ankit, Nadig Nandita R
Department of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
Crit Care Explor. 2023 Sep 7;5(9):e0965. doi: 10.1097/CCE.0000000000000965. eCollection 2023 Sep.
Transfer of select, medically refractory acute respiratory distress syndrome patients to lung transplant centers requires extensive resources. Here, we report 270 consecutive lung transplant patient referrals to our center for medically refractory ARDS from June 2021 to April 2022, following the implementation of clinical care pathways for intake of these patients. Eighty-seven of 270 patients (32.2%) met screening criteria and were evaluated for transfer within a median of 12 days, during which 38 of 87 patients (43.7%) died and 12 of 87 patients (13.8%) transferred elsewhere. Thirty-seven of 87 patients (42.5%) were accepted for transfer of which 16 of 37 patients (43.2%) successfully transferred to our center with a median transfer waiting period of 12 days. Because of resource constraints, 21 of 37 accepted patients (56.8%) could not be transferred of which 9 of 21 patients (42.9%) died while waiting. Nine of 16 transferred patients (56.2%) eventually underwent lung transplantation with over 80% 6-month survival. ARDS patients referred for transplantation have high risk of mortality and, therefore, require well-described pathways for evaluation and transfer.
将选定的、药物治疗无效的急性呼吸窘迫综合征患者转诊至肺移植中心需要大量资源。在此，我们报告了2021年6月至2022年4月期间，在实施了这些患者入院的临床护理路径后，连续270例因药物治疗无效的急性呼吸窘迫综合征转诊至我们中心的肺移植患者情况。270例患者中有87例（32.2%）符合筛查标准，并在中位数为12天的时间内接受了转诊评估，在此期间，87例患者中有38例（43.7%）死亡，87例患者中有12例（13.8%）转至其他地方。87例患者中有37例（42.5%）被接受转诊，其中37例患者中有16例（43.2%）成功转至我们中心，转诊等待期中位数为12天。由于资源限制，37例被接受的患者中有21例（56.8%）无法转诊，其中21例患者中有9例（42.9%）在等待期间死亡。16例转诊患者中有9例（56.2%）最终接受了肺移植，6个月生存率超过80%。转诊进行移植的急性呼吸窘迫综合征患者有很高的死亡风险，因此，需要有详细描述的评估和转诊路径。
