Xuan Chenhao, Gu Jingxiao, Chen Jingyu, Xu Hongyang
The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi Medical Center, Nanjing Medical University, Wuxi 214023, Jiangsu, China.
Wuxi Lung Transplant Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi 214023, Jiangsu, China.
J Int Med Res. 2024 Jun;52(6):3000605241259442. doi: 10.1177/03000605241259442.
To investigate the association between driving pressure (ΔP) and 90-day mortality in patients following lung transplantation (LTx) in patients who developed primary graft dysfunction (PGD).
This prospective, observational study involved consecutive patients who, following LTx, were admitted to our intensive care unit (ICU) from January 2022 to January 2023. Patients were separated into two groups according to ΔP at time of admission (i.e., low, ≤15 cmHO or high, >15 cmHO). Postoperative outcomes were compared between groups.
In total, 104 patients were involved in the study, and of these, 69 were included in the low ΔP group and 35 in the high ΔP group. Kaplan-Meier analysis of 90-day mortality showed a statistically significant difference between groups with survival better in the low ΔP group compared with the high ΔP group. According to Cox proportional regression model, the variables independently associated with 90-day mortality were ΔP and pneumonia. Significantly more patients in the high ΔP group than the low ΔP group had PGD grade 3 (PGD3), pneumonia, required tracheostomy, and had prolonged postoperative extracorporeal membrane oxygenation (ECMO) time, postoperative ventilator time, and ICU stay.
Driving pressure appears to have the ability to predict PGD3 and 90-day mortality of patients following LTx. Further studies are required to confirm our results.
探讨肺移植（LTx）术后发生原发性移植肺功能障碍（PGD）的患者中，驱动压（ΔP）与90天死亡率之间的关联。
这项前瞻性观察性研究纳入了2022年1月至2023年1月期间在我们重症监护病房（ICU）接受LTx术后连续入院的患者。根据入院时的ΔP将患者分为两组（即低，≤15 cmH₂O或高，>15 cmH₂O）。比较两组的术后结局。
共有104例患者参与研究，其中69例纳入低ΔP组，35例纳入高ΔP组。90天死亡率的Kaplan-Meier分析显示两组之间存在统计学显著差异，低ΔP组的生存率高于高ΔP组。根据Cox比例回归模型，与90天死亡率独立相关的变量是ΔP和肺炎。高ΔP组中PGD 3级（PGD3）、肺炎、需要气管切开术以及术后体外膜肺氧合（ECMO）时间、术后呼吸机使用时间和ICU住院时间延长的患者明显多于低ΔP组。
驱动压似乎有能力预测LTx术后患者的PGD3和90天死亡率。需要进一步研究来证实我们的结果。
