When to Remove Tracheal Intubation During ECMO Support in Lung Transplant Patients With Idiopathic Pulmonary Fibrosis

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-04-29 DOI:10.1016/j.transproceed.2025.03.026

Jing Tian, Ke Jin, Yan Dong, Hongyang Xu

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引用次数: 0

Abstract

Background

Lung transplantation is the optimal treatment choice, while extracorporeal membrane oxygenation (ECMO) provides cardiopulmonary support during the perioperative period of lung transplantation. Currently, there is no reported research on the ECMO withdrawal and duration of mechanical ventilation (MV) in idiopathic pulmonary fibrosis (IPF) patients undergoing lung transplantation. Therefore, this study aims to evaluate the impact of ECMO duration on prolonged mechanical ventilation (PMV) time in patients, attempting to explore the relationship between the two.

Methods

This study included 170 patients with IPF who underwent lung transplantation under ECMO technology. The patients were divided into normal and delayed groups based on the ECMO application time of 72 hours. A multifactor logistic regression analysis was conducted to explore the independent risk factors for PMV time, and restricted cubic spline (RCS) was used to investigate the relationship between ECMO application time and MV time. Receptor operating characteristics (ROC) were further used to find the cut-off value of ECMO application time to predict PMV time.

Results

In the normal group, there were 135 cases, of which 79.25% (107 cases) were males and 20.74% (28 cases) were females, whereas in the delayed group, there were 35 cases, of which 57.14% (20 cases) were males and 42.86% (15 cases) were females. In the RCS curves, there was a nonlinear correlation between the duration of ECMO application and the duration of MV, which tended to increase as the duration of ECMO application increased. According to univariate and multivariate logistic analyses, ECMO application time was an influential factor in the occurrence of PMV time, in which the OR of PMV time was 2.02 (95% CI 1.11,1.63, P = .001) when ECMO application time was ≥ 52.01 hours.

Conclusion

After lung transplantation, there is a nonlinear relationship between the application time of ECMO and MV time in patients with IPF. The application time of ECMO can predict well the extension of MV in patients during ICU stay. Therefore, clinicians can assess the duration of MV in patients with IPF based on the application time of ECMO, further avoiding complications related to MV.

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肺移植伴特发性肺纤维化患者在ECMO支持下何时拔除气管插管。

背景：肺移植是最佳的治疗选择，而体外膜氧合（ECMO）在肺移植围手术期提供了心肺支持。目前，关于特发性肺纤维化（IPF）患者肺移植术后ECMO停药和机械通气时间（MV）的研究尚未见报道。因此，本研究旨在评估ECMO持续时间对患者延长机械通气（PMV）时间的影响，试图探讨两者之间的关系。方法：170例IPF患者在ECMO技术下行肺移植。按ECMO应用时间72h分为正常组和延迟组。采用多因素logistic回归分析探讨PMV时间的独立危险因素，采用限制性三次样条（RCS）分析ECMO应用时间与PMV时间的关系。进一步利用受体工作特征（ROC）寻找ECMO应用时间的截止值来预测PMV时间。结果：正常组135例，其中男性107例（79.25%），女性28例（20.74%）；延迟组35例，男性20例（57.14%），女性15例（42.86%）。在RCS曲线中，ECMO应用时间与MV持续时间呈非线性相关关系，且随ECMO应用时间的增加，MV持续时间呈增加趋势。单因素和多因素logistic分析显示，ECMO应用时间是PMV时间发生的影响因素，当ECMO应用时间≥52.01 h时，PMV时间的OR为2.02 （95% CI 1.11,1.63, P = 0.001）。结论：IPF患者肺移植后ECMO应用时间与MV时间呈非线性关系。ECMO的应用时间可以较好地预测患者在ICU期间的MV延长。因此，临床医生可以根据ECMO的应用时间来评估IPF患者的MV持续时间，进一步避免与MV相关的并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.