Department of Pulmonology and Respiratory Medicine, Lung Center Stuttgart-Schillerhoehe Lung Clinic GmbH, Robert-Bosch-Hospital GmbH, Stuttgart, Germany.
Department of Medicine V, LMU University Hospital, LMU Munich, Munich, Germany.
Transpl Int. 2023 Sep 20;36:11506. doi: 10.3389/ti.2023.11506. eCollection 2023.
Prolonged mechanical ventilation (PMV) after lung transplantation poses several risks, including higher tracheostomy rates and increased in-hospital mortality. Mechanical power (MP) of artificial ventilation unifies the ventilatory variables that determine gas exchange and may be related to allograft function following transplant, affecting ventilator weaning. We retrospectively analyzed consecutive double lung transplant recipients at a national transplant center, ventilated through endotracheal tubes upon ICU admission, excluding those receiving extracorporeal support. MP and derived indexes assessed up to 36 h after transplant were correlated with invasive ventilation duration using Spearman's coefficient, and we conducted receiver operating characteristic (ROC) curve analysis to evaluate the accuracy in predicting PMV (>72 h), expressed as area under the ROC curve (AUROC). PMV occurred in 82 (35%) out of 237 cases. MP was significantly correlated with invasive ventilation duration (Spearman's = 0.252 [95% CI 0.129-0.369], < 0.01), with power density (MP normalized to lung-thorax compliance) demonstrating the strongest correlation ( = 0.452 [0.345-0.548], < 0.01) and enhancing PMV prediction (AUROC 0.78 [95% CI 0.72-0.83], < 0.01) compared to MP (AUROC 0.66 [0.60-0.72], < 0.01). Mechanical power density may help identify patients at risk for PMV after double lung transplantation.
肺移植后长时间机械通气（PMV）会带来多种风险，包括气管切开率升高和院内死亡率增加。人工通气的机械功率（MP）统一了决定气体交换的通气变量，可能与移植后供体肺的功能有关，从而影响呼吸机脱机。我们回顾性分析了一家国家移植中心连续的双肺移植受者，这些受者在 ICU 入院时通过气管内插管通气，不包括接受体外支持的患者。在移植后最多 36 小时内评估 MP 和衍生指标，使用 Spearman 系数与有创通气时间相关，我们进行了受试者工作特征（ROC）曲线分析，以评估预测 PMV（>72 小时）的准确性，用 ROC 曲线下面积（AUROC）表示。237 例患者中 82 例（35%）发生 PMV。MP 与有创通气时间显著相关（Spearman's = 0.252 [95% CI 0.129-0.369]， < 0.01），功率密度（MP 与肺胸廓顺应性的比值）相关性最强（ = 0.452 [0.345-0.548]， < 0.01），并提高了 PMV 预测的准确性（AUROC 0.78 [95% CI 0.72-0.83]， < 0.01），优于 MP（AUROC 0.66 [0.60-0.72]， < 0.01）。机械功率密度可能有助于识别双肺移植后发生 PMV 的高危患者。
