Nutritional status, ICU duration and ICU mortality in lung transplant recipients

ObjectiveTo determine the relation of malnutrition and underlying diagnosis to the length of stay in the Intensive Care Unit (ICU) and to mortality after lung transplantation (LTX).DesignRetrospective ICU chart review.SettingCardiothoracic ICU in a University hospital.PatientsFifty-one consecutive patients who suffered from end-stage lung disease from. April 1992 to January 1994.InterventionsNone.Measurements and resultsThe median time spent in the ICU was 5 days (range, 2–123 days). Patients with an underlying diagnosis of obstructive lung disease had significantly shorter ICU stays (median 4 days; range, 2–28 days) than those with restrictive lung disease (median 7 days; range, 2–123 days) (p=0.005) or pulmonary hypertension (median 10 days; range, 2–38 days) (p=0.041). Significant differences in ICU duration were observed between patients after double lung transplantation (median 10 days; range, 2–123 days) and those after single lung transplantation (median 4 days; range, 2–36 days) (p=0.004). No statistically significant difference in ICU duration was found between patients with different nutritional statuses. In those patients who could not be discharged from the ICU before the 5th day, a body mass index (BMI) below the 25th percentile was a statistically significant risk factor for ICU mortality (p<0.05).ConclusionsWe conclude that the type of transplant procedure and the underlying diagnosis are important predictive indicators of ICU duration. A poor nutritional status (BMI below the 25th percentile) is a risk factor for ICU mortality in cases of patients who stay for 5 days or longer in the ICU.

[1]  J. Egan,et al.  Single lung transplantation for emphysema: predictors for native lung hyperinflation. , 1998, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[2]  R. Chandra NUTRITION, IMMUNITY, AND INFECTION: PRESENT KNOWLEDGE AND FUTURE DIRECTIONS , 1983, The Lancet.

[3]  F. Detterbeck,et al.  Lung transplantation after previous thoracic surgical procedures. , 1995, The Annals of thoracic surgery.

[4]  J. Maurer,et al.  Causes of death in lung transplant recipients. , 1994, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[5]  M. Pasque,et al.  Differences in early results after single-lung transplantation. Washington University Lung Transplant Group. , 1994, The Annals of thoracic surgery.

[6]  W. Klepetko,et al.  One and One‐Half Year Experience with Unilateral and Bilateral Lung Transplantation , 1992, Journal of cardiac surgery.

[7]  J. Kalden,et al.  Letter: Sézary syndrome. , 1974, Lancet.

[8]  G. Verleden,et al.  Growth hormone as a rescue treatment after heart-lung or double-lung transplantation , 1994 .

[9]  M. Otaki Surgical treatment of patients with cardiac cachexia. An analysis of factors affecting operative mortality. , 1994, Chest.

[10]  D. V. van Thiel,et al.  Nutritional status and lung function in patients with emphysema and chronic bronchitis. , 1983, Chest.

[11]  G. Hill,et al.  Grip strength: A measure of the proportion of protein loss in surgical patients , 1988, The British journal of surgery.

[12]  J. Mullen Consequences of malnutrition in the surgical patient. , 1981, The Surgical clinics of North America.

[13]  D. Wilmore Catabolic illness. Strategies for enhancing recovery. , 1991, The New England journal of medicine.

[14]  A. Roche,et al.  Race- and sex-specific reference data for triceps and subscapular skinfolds and weight/stature. , 1982, The American journal of clinical nutrition.

[15]  B. Griffith,et al.  Influence of the donor lung on development of early infections in lung transplant recipients. , 1990, The Journal of heart transplantation.

[16]  L. Sharples,et al.  Prognosis of patients with cystic fibrosis awaiting heart and lung transplantation. , 1993, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[17]  Hunter Am,et al.  The nutritional status of patients with chronic obstructive pulmonary disease. , 1981 .

[18]  E. Garrity,et al.  Survival and functional outcome after single and bilateral lung transplantation. Loyola Lung Transplant Team. , 1994, Surgery.

[19]  A. Menkis,et al.  New trends in lung preservation: a collective review. , 1992, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[20]  P. Macklem,et al.  Inspiratory muscle strength and body composition in patients receiving total parenteral nutrition therapy. , 1984, The American review of respiratory disease.

[21]  M. Sharpe,et al.  Degree of preoperative malnutrition is predictive of postoperative morbidity and mortality in liver transplant recipients. , 1994, Transplantation.

[22]  M. Pasque,et al.  Predictors, frequency, and indications for cardiopulmonary bypass during lung transplantation in adults. , 1994, The Annals of thoracic surgery.

[23]  C. Mccord,et al.  Malnutrition: an important determinant of fatal outcome in surgically treated pulmonary suppurative disease. , 1989, Journal of the National Medical Association.

[24]  Kaye Mp The Registry of the International Society for Heart and Lung Transplantation: tenth official report--1993. , 1993, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[25]  G. Gorse,et al.  Association of malnutrition with nosocomial infection. , 1989 .

[26]  G. S. Knight,et al.  Wound healing response in surgical patients: Recent food intake is more important than nutritional status , 1988, The British journal of surgery.

[27]  G. Gorse,et al.  Association of Malnutrition with Nosocomial Infection , 1989, Infection Control &#x0026; Hospital Epidemiology.