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Tesi etd-02202017-213614


Tipo di tesi
Tesi di laurea specialistica LC6
Autore
ASSENZO, CRISTINA
URN
etd-02202017-213614
Titolo
Extubation in Operating Room after Bilateral-lung Transplantation in Adult Emphysema Patients: Success rate and Outcomes
Struttura
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Corso di studi
MEDICINA E CHIRURGIA
Commissione
relatore Prof. Forfori, Francesco
correlatore Prof. Liu, Ngai
Parole chiave
  • extubation
  • emphysema
  • bilateral-lung transplantation
Data inizio appello
14/03/2017;
Consultabilità
parziale
Data di rilascio
14/03/2020
Riassunto analitico
Background:

The aim of this study was to compare adult emphysema patients extubated in the operating room (OR) followed by non-invasive ventilation to patients extubated in the intensive care unit (ICU) after bilateral-lung transplantation (BLT).

Methods:

A single-center retrospective database analysis of 91 patients (May 2007-september 2016). Anesthesia was performed using automated titration of propofol and remifentanil combined with thoracic epidural analgesia. Data are expressed as number (percentage) or medians (25th-75th percentile).

Results:

Forty-nine (54%) patients were extubated in the OR group with one (2%) requiring reintubation and 42 (46%) in the ICU. Patients, donor and intraoperative characteristics were similar between groups. But the need for or use of intraoperative extracorporeal membrane oxygenation (ECMO) (3 (6) vs 19 (45) patients, p<0.0001) and ex-vivo lung reconditioning (2 (4) vs 9 (21) patients, p=0.021) were lower in the OR group. At the procedure end, the PaO2/FiO2 ratio was better (345 (283-424) vs 209 (156-397), p<0.0001), OR vs ICU group respectively. The need of postoperative ECMO (0(0) vs 9 (21), p<0.0001), mechanical ventilation duration (0 (0-1 vs 7 (2-14) days, p<0.0001), tracheostomy (4 (8) vs 17 (40) patients, p<0.0001), length of stay in the ICU (5 (4-7) vs 12 (7-19) days, p<0.0001) and the rate of grade-3 primary graft dysfunction (2 (4) vs 19 (48), p<0.0001) were lower in the OR group.

Conclusions:

Half of the patients were extubated in the OR and they had better outcomes. Ex-vivo lung reconditioning or intraoperative use of ECMO decreased the rate of extubation in the OR.
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