Operating Room Extubation After Bilateral Lung Transplantation in Cystic Fibrosis Patients: A Single Center Experience

M.-L. Felten,¹ J.-D. Moyer,¹ J.-Y. Marandon,¹ J.-F. Dreyfus,² M. Fischler.¹

¹Anesthesiology Department, Foch Hospital, Suresnes, Hauts-de-Seine, France
²Research and Innovation Department, Foch Hospital, Suresnes, Hauts-de-Seine, France.

Meeting: 2015 American Transplant Congress

Abstract number: B217

Keywords: Lung transplantation

Session Information

Session Name: Poster Session B: Lung- All Topics

Session Type: Poster Session

Date: Sunday, May 3, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

Short-acting anesthetic drugs, thoracic epidural analgesia and a strict ventilation weaning protocol could permit extubation in the operating room (OR) (1). Aims of this study were to evaluate its feasibility in cystic fibrosis patients. 89 recipients, having benefited from lung transplantation between May 2007 and June 2013, were eligible to a standardized protocol. 41 patients (46%) were extubated in the OR (ORE group) and extubation was delayed in 48 cases (54%) (DE group). Donor and patient characteristics were similar between groups. Intraoperative events occurred less frequently in the ORE group. Postoperative courses were different, especially PGD grade 3 (0 vs 19 patients in the DE group, p < 0.0001), ICU and hospital stays (5.0 [3.7 – 7.2] (ORE) vs 11.5 [7.0 – 15.5] days and 22.0 [18.0 – 25.5] (ORE) vs 33.0 [25.0 – 56.5] days respectively, p< 0.0001). One-year survival was similar: 95% (ORE) vs 98%. Our protocol permitted OR-extubation of 46% of our cystic fibrosis double-lung recipients without increased postoperative risks.

Intraoperative data
		ORE group (N= 41)	DE group (N= 48)	P
	Initial ventilation events	9 (22)	12 (25)	0.81
1st graft	Ventilation events	9 (22)	19 (40)	0.11
	Cross-clamping events	13 (32)	20 (42)	0.38
	Unclamping events	10 (24)	15 (31)	0.49
2nd graft	Ventilation events	3 (7)	23 (48)	< 0.001
	Cross-clamping events	4 (10)	19 (40)	0.001
	Unclamping events	9 (22)	18 (38)	0.17
	Ischemic time (min)	345.0 [282.5 – 392.5]	360.0 [303.2 – 433.5]	0.17
End of surgery	Ventilation events	3 (7)	33 (69)	< 0.001
	Intraoperative ECMO	7 (17)	20 (42)	0.02
	RBC (mL/kg)	20.0 [15.5 – 29.5]	26.0 [20.0- 38.7]	0.01
	Colloid (mL/kg)	30.0 [19.5- 36.0]	35.0 [24.0- 47.0]	0.01
	Platelets (number of patients)	3 (7)	12 (25)	0.04
	Lactatemia (mmol/L)	2.3 [1.6 – 2.9]	2.8 [1.82 – 3.6]	0.03
Weaning protocol	PaO2/FiO2 ratio	357.0 [299.0 – 418.4]	186.5 [119.5 – 277.0]	< 0.001

Data are expressed as numbers (%) and medians [25th percentiles – 75th percentiles] and are compared using Fisher's exact test and the Mann-Whitney test.

Reference: 1. Augoustides et al Interactive Cardiovascular and thoracic surgery 2008; 7: 755-758.

To cite this abstract in AMA style:

Felten M-L, Moyer J-D, Marandon J-Y, Dreyfus J-F, Fischler M. Operating Room Extubation After Bilateral Lung Transplantation in Cystic Fibrosis Patients: A Single Center Experience [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/operating-room-extubation-after-bilateral-lung-transplantation-in-cystic-fibrosis-patients-a-single-center-experience/. Accessed November 23, 2024.

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