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Respiratory Failure and Sepsis Are the Major Causes of ICU Admissions and Mortality in Survivors of Lung Transplants^*

^* From the Cleveland Clinic Foundation, Cleveland, OH.

Correspondence to: Omar A. Minai, MD, Department of Pulmonary and Crit Care Med, A-90, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195; e-mail: minaio{at}ccf.org

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

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