HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Currey, J. Articles by Snell, G. Search for Related Content PubMed PubMed Citation Articles by Currey, J. Articles by Snell, G. Related Collections Lung - transplantation

J Thorac Cardiovasc Surg 2010;139:154-161
© 2010 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Implementation of a management guideline aimed at minimizing the severity of primary graft dysfunction after lung transplant

^a Faculty of Health, Medicine, Nursing and Behavioural Sciences, Deakin University, Burwood, Victoria, Australia
^b Department of Intensive Care Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
^c Lung Transplant Service, The Alfred Hospital, Melbourne, Victoria, Australia
^d Australian & New Zealand Intensive Care Research Centre, Department of Epidemiology & Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia

Received for publication December 16, 2008; revisions received July 14, 2009; accepted for publication August 9, 2009.

^_* Address for reprints: Judy Currey, PhD, RN, Faculty of Health, Medicine, Nursing and Behavioural Sciences, Deakin University, 221 Burwood Hwy, Burwood 3125, Victoria, Australia. (Email: judy.currey{at}deakin.edu.au).

Objective: Primary graft dysfunction, a severe form of lung injury that occurs in the first 72 hours after lung transplant, is associated with morbidity and mortality. We sought to assess the impact of an evidence-based guideline as a protocol for respiratory and hemodynamic management.

Methods: Preoperative and postoperative data for patients treated per the guideline (n = 56) were compared with those of a historical control group (n = 53). Patient data such as ratio of arterial PO ₂ to inspired oxygen fraction, central venous pressure, cumulative fluid balance, vasopressor dose, and serum urea and creatinine were measured and documented at specific times. Primary outcome was severity of primary graft dysfunction within the first 72 hours.

Results: Primary graft dysfunction grade was progressively lower in patients treated after introduction of the guideline (P = .01). Lower postoperative fluid balances (P = .01) and vasopressor doses (P = .007) were seen, with no associated renal dysfunction. There were no differences in duration of mechanical ventilation or mortality. Nonadherence to the guideline occurred in 10 cases (18%).

Conclusions: Implementation of an evidence-based guideline for managing respiratory and hemodynamic status is feasible and safe and was associated with reduction in severity of primary graft dysfunction. Further studies are required to determine whether such a guideline would lead to a consistent reduction in severity of primary graft dysfunction at other institutions. Creation of a protocol for postoperative care provides a template for further studies of novel therapies or management strategies for primary graft dysfunction.