Implementation of a management guideline aimed at minimizing the severity of primary graft dysfunction after lung transplant

Currey, Judy, Pilcher, David V., Davies, Andrew, Scheinkestel, Carlos, Botti, Mari, Bailey, Michael and Snell, Greg 2010, Implementation of a management guideline aimed at minimizing the severity of primary graft dysfunction after lung transplant, Journal of thoracic and cardiovascular surgery, vol. 139, no. 1, pp. 154-161.

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Title Implementation of a management guideline aimed at minimizing the severity of primary graft dysfunction after lung transplant
Author(s) Currey, Judy
Pilcher, David V.
Davies, Andrew
Scheinkestel, Carlos
Botti, Mari
Bailey, Michael
Snell, Greg
Journal name Journal of thoracic and cardiovascular surgery
Volume number 139
Issue number 1
Start page 154
End page 161
Total pages 8
Publisher Mosby, Inc
Place of publication St. Louis, Mo.
Publication date 2010-01
ISSN 0022-5223
1097-685X
Summary Objective
Primary graft dysfunction, a severe form of lung injury that occurs in the first 72 hours after lung transplant, is associated with morbidity and mortality. We sought to assess the impact of an evidence-based guideline as a protocol for respiratory and hemodynamic management.

Methods
Preoperative and postoperative data for patients treated per the guideline (n = 56) were compared with those of a historical control group (n = 53). Patient data such as ratio of arterial Po2 to inspired oxygen fraction, central venous pressure, cumulative fluid balance, vasopressor dose, and serum urea and creatinine were measured and documented at specific times. Primary outcome was severity of primary graft dysfunction within the first 72 hours.

Results
Primary graft dysfunction grade was progressively lower in patients treated after introduction of the guideline (P = .01). Lower postoperative fluid balances (P = .01) and vasopressor doses (P = .007) were seen, with no associated renal dysfunction. There were no differences in duration of mechanical ventilation or mortality. Nonadherence to the guideline occurred in 10 cases (18%).

Conclusions
Implementation of an evidence-based guideline for managing respiratory and hemodynamic status is feasible and safe and was associated with reduction in severity of primary graft dysfunction. Further studies are required to determine whether such a guideline would lead to a consistent reduction in severity of primary graft dysfunction at other institutions. Creation of a protocol for postoperative care provides a template for further studies of novel therapies or management strategies for primary graft dysfunction.
Language eng
Field of Research 110309 Infectious Diseases
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2010, American Association for Thoracic Surgery
Persistent URL http://hdl.handle.net/10536/DRO/DU:30031118

Document type: Journal Article
Collections: School of Nursing and Midwifery
Higher Education Research Group
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Created: Tue, 09 Nov 2010, 13:52:15 EST by Jane Moschetti

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