Initial experience with lung transplantation in Estonia.

BACKGROUND: A lung transplant program in Estonia was initiated in cooperation with the Medical University of Vienna. The first lung transplantation for an Estonian patient was performed in Vienna on April 28, 2009. The waiting list in Estonia was opened on May 28, 2010; the first transplantation was performed on October 7, 2010. The aim of this study was to present our initial results. PATIENTS AND METHODS: All lung transplantations performed in Estonia through the end of January 2012 included 2 female and 3 male patients of age from 52 to 64 years. Data regarding the donor, the transplant operation, postoperative period, and follow-up were extracted from case records. RESULTS: The cases included 1 bilateral lobar, 3 double, and 1 single lung transplantations. Two patients had chronic obstructive pulmonary disease, one alpha-1 trypsin deficiency, and two idiopathic pulmonary fibrosis. The operative duration varied from 172 to 337 minutes; the ischemia times for the first and second lung ranged from 191 to 351 and 303 to 455 minutes, respectively. Duration of postoperative mechanical ventilation ranged from 2 to 14 days (median 3) and the hospital stay from 28 to 72 days. The following complications were observed: prolonged air leak in 2 patients, one of whom required rethoracotomy; phrenic nerve palsy in 2, atrial fibrillation in 2, and mild renal failure in 1 subject. One patient needed readmission to the intensive care unit owing to acute respiratory failure; one, a tracheostomy for weaning from the ventilator, and one, noninvasive ventilation owing to hypercapnia. All patients remain well at 4-19 months after transplantation. No episodes of acute rejection or bronchiolitis obliterans have been diagnosed. CONCLUSION: The first 1.5-year experience with lung transplantation in Estonia has been satisfactory. Although there have been several complications, no posttransplant or waiting list mortality has occurred.

Risk factors for intra-abdominal hypertension in mechanically ventilated patients.

BACKGROUND: Intra-abdominal hypertension (IAH) in intensive care patients is associated with an adverse outcome, but the risk factors for development of IAH have not been extensively studied. We aimed to identify independent risk factors for IAH in mechanically ventilated (MV) patients. METHODS: In this prospective observational study, 563 MV patients staying in the general intensive care unit (ICU) of a university hospital for more than 24 h were observed during their ICU stay. Repeated intermittent measurements of intra-abdominal pressure (IAP) via the urinary bladder were performed. RESULTS: IAH (sustained or repeated IAP≥12 mmHg) developed in 182 patients (32.3%). From all the study patients, 44.4% had a primary pathology in the abdomino-pelvic region. Two thirds of all IAH cases developed in this group. Obesity [body mass index (BMI)>30], high positive end-expiratory pressure (PEEP>10), respiratory failure (PaO(2)/FiO(2) <300), use of vasopressors/inotropes, pancreatitis, hepatic failure/cirrhosis with ascites, gastrointestinal bleeding and laparotomy on admission day were identified as independent risk factors for IAH. None of the patients without any of these risk factors (26 patients) developed IAH. CONCLUSION: The precise prediction of development IAH in mixed ICU population remains difficult. In the absence of BMI>30, PEEP>10 cmH(2)O, PaO(2)/FiO(2) <300, use of vasopressors/inotropes, pancreatitis, hepatic failure/cirrhosis with ascites, gastrointestinal bleeding and laparotomy on admission day, the risk for development of IAH in MV ICU patients is minimal.

Gastrointestinal symptoms in intensive care patients.

BACKGROUND: Gastrointestinal (GI) problems are not uniformly assessed in intensive care unit (ICU) patients and respective data in available literature are insufficient. We aimed to describe the prevalence, risk factors and importance of different GI symptoms. METHODS: We prospectively studied all patients hospitalized to the General ICU of Tartu University Hospital in 2004-2007. RESULTS: Of 1374 patients, 62 were excluded due to missing data. Seven hundred and seventy-five (59.1%) patients had at least one GI symptom at least during 1 day of their stay, while 475 (36.2%) suffered from more than one symptom. Absent or abnormal bowel sounds were documented in 542 patients (41.3%), vomiting/regurgitation in 501 (38.2%), high gastric aspirate volume in 298 (22.7%), diarrhoea in 184 (14.0%), bowel distension in 139 (10.6%) and GI bleeding in 97 (7.4%) patients during their ICU stay. Absent or abnormal bowel sounds and GI bleeding were associated with significantly higher mortality. The number of simultaneous GI symptoms was an independent risk factor for ICU mortality. The ICU length of stay and mortality of patients who had two or more GI symptoms simultaneously were significantly higher than in patients with a maximum of one GI symptom. CONCLUSION: GI symptoms occur frequently in ICU patients. Absence of bowel sounds and GI bleeding are associated with impaired outcome. Prevalence of GI symptoms at the first day in ICU predicts the mortality of the patients.