BJA Advance Access originally published online on February 17, 2009
British Journal of Anaesthesia 2009 102(4):506-514; doi:10.1093/bja/aep008
Does anaesthetic management affect early outcomes after lung transplant? An exploratory analysis
1 Department of Anaesthesia and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Australia
2 Department of Anesthesiology, Columbia-Presbyterian Medical Center, New York, NY, USA
3 Department of Intensive Care Medicine
4 Department of Respiratory Medicine, Alfred Hospital, Melbourne, Australia
* Corresponding author: Department of Anesthesiology, Columbia-Presbyterian Medical Center, 622 W 168th Street, New York, NY 10032, USA. E-mail: dm2655{at}columbia.edu
Background: Primary graft dysfunction (PGD) is a predominant cause of early morbidity and mortality after lung transplantation. Although substantial work has been done to understand risk factors for PGD in terms of donor, recipient, and surgical factors, little is understood regarding the potential role of anaesthetic management variables in its development.
Methods: We conducted a retrospective exploratory analysis of 107 consecutive lung transplants to determine if anaesthesia factors were associated with early graft function quantified by PaO2/FIO2. Multivariate regression techniques were used to explore the association between anaesthetic management variables and PaO2/FIO2 ratio 12 h after operation. The relationship between these variables and both time to tracheal extubation and intensive care unit (ICU) length of stay was further examined using the Cox proportional hazards.
Results: On multivariate analysis, increasing volume of intraoperative colloid, comprising predominantly Gelofusine® (succinylated gelatin), was independently associated with a lower PaO2/FIO2 12 h post-transplantation [β coefficient –42 mm Hg, 95% confidence interval (CI) –7 to –77 mm Hg, P=0.02] and reduced rate of extubation [hazard ratio (HR) 0.65, 95% CI 0.49–0.84, P=0.001]. There was a trend for intraoperative colloid to be associated with a reduced rate of ICU discharge (HR 0.79, 95% CI 0.31–1.02, P=0.07).
Conclusions: We observed an inverse relationship between volume of intraoperative colloid and early lung allograft function. The association persists, despite detailed sensitivity analyses and adjustment for potential confounding variables. Further studies are required to confirm these findings and explore potential mechanisms through which these associations may act.
Keywords: lung, gas exchange, respiratory; lung, transplantation
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