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J Thorac Cardiovasc Surg 2005;130:180-186
© 2005 The American Association for Thoracic Surgery
Cardiothoracic Transplantation |
a Department of Cardiothoracic Surgery, Allergy, Immunology, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia.
b Department of Respiratory Medicine, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia.
c Department of Intensive Care Medicine, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia.
d Department of Epidemiology and Preventive Medicine, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia.
Received for publication August 4, 2004; revisions received October 13, 2004; accepted for publication October 28, 2004. * Address for reprints: Takahiro Oto, MD, Department of Cardiothoracic Surgery, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia (Email: takahirooto{at}aol.com).
OBJECTIVE: Despite the clinical importance of early graft dysfunction, no standardized definition is available. We hypothesized that the arterial blood gas oxygen tension/fraction of inspired oxygen ratio (PaO 2/FIO 2) would prove to be a useful marker for predicting subsequent outcomes of early graft dysfunction. The aims of this study were to define the prevalence of various ranges of PaO 2/FIO 2 over the first 48 hours after lung transplantation and to evaluate which measurement using the PaO 2/FIO 2 best correlates with the duration of intubation, the length of stay in the intensive care unit, and 30-day mortality, which are important alternative indicators of early graft performance.
METHODS: A retrospective study was performed that included all 68 bilateral single-lung transplantations at The Alfred Hospital from January 2000 to December 2002.
RESULTS: PaO 2/FIO 2 at 6 and 12 hours after admission to the intensive care unit was significantly associated with the duration of intubation (r = –0.44; P < .001 and r = –0.48; P < .001, respectively), and PaO 2/FIO 2 at 6 and 24 hours was also significantly associated with the length of intensive care unit stay (r = –0.38; P = .002 and r = –0.44; P = .001, respectively). Thirty-day mortality was significantly associated with a lower PaO 2/FIO 2 at 6 hours (219 ± 93 vs 306 ± 101; P = .03).
CONCLUSIONS: PaO 2/FIO 2 taken between 6 and 12 hours after transplantation is a useful marker associated with lung transplantation outcomes. There is the potential for therapeutic interventions during this time that may be able to enhance PaO 2/FIO 2 by 12 hours and improve subsequent outcomes.
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