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Chest. 2003;123:504-509.)

© 2003 American College of Chest Physicians

Respiratory Failure and Sepsis Are the Major Causes of

ICU Admissions and Mortality in Survivors of Lung

Transplants*

Celestino Pietrantoni, DO; A. Minai, MD;

C. Yu, MD; Janet R. Maurer, MD, FCCP; Marcus T. Haug,

III, PharmD; Atul C. Mehta, MD, FCCP and C.

Arroliga, MD, FCCP

* From the Cleveland Clinic Foundation, Cleveland, OH.

Correspondence to: A. Minai, MD, Department of

Pulmonary and Crit Care Med, A-90, Cleveland Clinic

Foundation, 9500 Euclid Ave, Cleveland, OH 44195;

e-mail: minaio@...

Study objective: To identify outcome predictors and

prognostic factors in long-term survivors (> 30 days

post-transplant) of single-lung and double-lung

transplants on readmission to the medical ICU (MICU).

Design: Retrospective study.

Setting: MICU of the Cleveland Clinic Foundation, a

lung transplantation center.

Patients: As of August 2000, 210 lung transplantations

have been performed at our institution. The records of

33 lung transplant recipients who required readmission

to the MICU after the initial 30-day post-transplant

period over a 4-year period from August 16, 1996 to

August 15, 2000 were reviewed.

Results: Thirty-three patients had a total of 46 MICU

readmissions. Twenty-seven MICU admissions (59%) were

due to respiratory deterioration with mechanical

ventilation (10 deaths), and 16 MICU admissions (35%)

were due to the systemic inflammatory response

syndrome (SIRS; 8 deaths). The MICU mortality rate was

37% per admission in our group of patients. A

preadmission diagnosis of bronchiolitis obliterans

syndrome was observed in 7 of 14 nonsurvivors (50%)

and in 5 of 25 patients (20%) surviving to hospital

discharge.

Conclusions: Respiratory failure and SIRS are the

predominant causes of MICU readmissions and are

frequent causes of death. APACHE (acute physiology and

chronic health evaluation) III scores, nonpulmonary

organ system dysfunction, initial serum albumin level,

and duration of mechanical ventilation are important

prognostic factors.

Key Words: ARDS • intensive care • lung transplant •

respiratory failure • sepsis

Becki

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