ABSTRACT
Advanced respiratory failure with tracheostomy requirement is common in heart recipients. The aim of the study is to assess the tracheostomy rate after orthotopic heart transplantation and identify the subgroups of patients with the highest need for tracheostomy and these groups' association with mortality at a single centre through a retrospective analysis of 140 consecutive patients transplanted between December 2012 and July 2018. As many as 28.6% heart recipients suffered from advanced respiratory failure with a need for tracheostomy that was performed after a median time of 11.5 days post-transplant. Tracheostomy was associated with a history of stroke (OR 3.4; 95% CI) 1.32-8.86; p = 0.012), previous sternotomy (OR 2.5; 95% CI 1.18-5.32; p = 0.017), longer cardiopulmonary bypass time (OR 1.01; 95% CI 1.00-1.01; p = 0.007) as well as primary graft failure (OR 6.79; 95% CI2.93-15.71; p < 0.001), need of renal replacement therapy (OR 19.2; 95% 2.53-146; p = 0.004) and daily mean SOFA score up to 72 h (OR 1.50; 95% 1.23-1.71; p < 0.01). One-year mortality was significantly higher in patients requiring a tracheostomy vs. those not requiring one during their hospital stay (50% vs. 16%, p < 0.001). The need for tracheostomy in heart transplant recipients was 30% in our study. Advanced respiratory failure was associated with over 3-fold greater 1-year mortality. Thus, tracheostomy placement may be regarded as a marker of unfavourable prognosis.
ABSTRACT
Aim: Hyperlactatemia is common post-heart transplantation. Lactate measurements in the first 24 h were analyzed with respect to mortality. Methods: A total of 153 consecutive cardiac transplant patients were reviewed. Recipients of organs maintained in a state of ex vivo perfusion were included. Results: A total of 143 heart recipients were included. Hyperlactatemia (>2 mmol/l) was present in all patients. Despite maximum lactate and lactate clearance being significantly higher in nonsurvivors (p = 0.002, p = 0.004), neither receiver operator curve analysis nor multivariate logistic regression showed association with 1-year mortality. In comparison, the minimum lactate was significantly associated with mortality (area under the curve 0.728 [p < 0.001]; odds ratio 1.28 [95% 1.01-162; p = 0.04]). Conclusion: The minimum lactate, a surrogate of persistent hyperlactatemia, was demonstrated to be superior compared with maximum lactate and lactate clearance in determining patient prognosis.
Subject(s)
Heart Transplantation , Hyperlactatemia , Heart Transplantation/adverse effects , Humans , Lactic Acid , Prognosis , Retrospective StudiesABSTRACT
Objetivos: monitorizar la adherencia a las recomendaciones de la Surviving Sepsis Campaign (Campaña Sobrevivir a la Sepsis) en las seis primeras horas de intervención de la sepsis grave/shock séptico en un hospital de tercer nivel.Métodos: se analizaron de manera observacional prospectiva los casos de pacientes que ingresaron durante los meses de Mayo-Junio del 2009 en la Unidad de Cuidados Intensivos del Complejo Hospitalario Universitario A Coruña, Galicia, España, con criterios de sepsis grave/shock séptico. Estudiamos cinco indicadores que constituyen el set de medidas de intervención en las seis primeras horas del diagnostico de sepsis grave/shock séptico: demora en el inicio de la resucitación, determinación del lactato sérico, recogida de cultivos previo a antibióticos, demora de inicio de antibiótico adecuado y resucitación inicial.Resultados: en los 13 pacientes estudiados, la mortalidad hospitalaria fue de un 30,8% (IC 95%: 9,09-61,42). El APACHE II medio fue de 25,46±9,38. La demora en el inicio de tratamiento antibiótico fue de 1,23±1,76 horas. La demora media de inicio de resucitación desde la presentación del cuadro fue de 3,83±8,85 horas. Un 84,62% (IC 95%: 54,55-98,08) lograron saturación venosa central de oxígeno superior al 70% en las seis primeras horas del diagnóstico.Conclusiones: la adherencia al paquete de medidas de resucitación de la sepsis grave/shock séptico fue elevada.
Aims: To monitor adherence to the recommendations of the Surviving Sepsis Campaign during the first six hours of intervention for severe sepsis/septic shock in an academic tertiary care center.Methods: Cases of patients who were admitted into the Intensive Care Unit of the University Hospital Complex A Coruña, Galicia, Spain, during the months of May-June 2009, with criteria for severe sepsis/septic shock, were analyzed using an observational prospective study. We studied five indicators that comprise the set of intervention measures within the first six hours of diagnosis of severe shock/septic shock: delay on the onset of resuscitation, determination of blood lactate, obtaining appropriate cultures before starting antibiotics, delay on the onset of appropriate antibiotics, and initial resuscitation.Results: In the 13 patients studied, hospital mortality was 30.8% (95% CI: 9.09-61.42). The average APACHE II was 25.46±9.38. The delay in initiation of antibiotic treatment was 1.23±1.76 hours. The average delay in initiation of resuscitation from presentation of symptoms was 3.83±8.85 hours. In 84.62% (95% IC: 54.55-98.08) of the patients, central oxygen saturation was higher than 70% within the first six hours of diagnosis.Conclusions: Adherence to the set of measures of resuscitation from severe sepsis/septic shock was high.
