COVID-19 大流行期间急性呼吸窘迫综合征患者肺移植评估转诊的单中心经验:如何弥补失去的时间?

Critical Care Explorations Pub Date : 2023-09-07 eCollection Date: 2023-09-01 DOI:10.1097/CCE.0000000000000965
Emily J Cerier, Takahide Toyoda, Colleen McNulty, Anne O'Boye, Chitaru Kurihara, Ankit Bharat, Nandita R Nadig
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摘要

将精选的难治性急性呼吸窘迫综合征患者转至肺移植中心需要大量资源。在此,我们报告了 2021 年 6 月至 2022 年 4 月期间,在实施临床护理路径接收这些患者后,连续有 270 例肺部移植患者因药物难治性 ARDS 转诊至我们的中心。270 名患者中有 87 名(32.2%)符合筛查标准,并在中位数 12 天内接受了转院评估,在此期间,87 名患者中有 38 名(43.7%)死亡,87 名患者中有 12 名(13.8%)转院至其他地方。87 名患者中有 37 名(42.5%)接受了转院治疗,其中 37 名患者中有 16 名(43.2%)成功转入本中心,转院等待时间中位数为 12 天。由于资源限制,37 名接受转院的患者中有 21 名(56.8%)无法转院,其中 21 名患者中有 9 名(42.9%)在等待期间死亡。16名转院患者中有9名(56.2%)最终接受了肺移植手术,6个月存活率超过80%。转诊接受移植手术的 ARDS 患者死亡风险很高,因此需要有完善的评估和转院路径。
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Single-Center Experience With Lung Transplant Evaluation Referrals of Acute Respiratory Distress Syndrome Patients During the COVID-19 Pandemic: How Do You Make Up For Lost Time?

Transfer of select, medically refractory acute respiratory distress syndrome patients to lung transplant centers requires extensive resources. Here, we report 270 consecutive lung transplant patient referrals to our center for medically refractory ARDS from June 2021 to April 2022, following the implementation of clinical care pathways for intake of these patients. Eighty-seven of 270 patients (32.2%) met screening criteria and were evaluated for transfer within a median of 12 days, during which 38 of 87 patients (43.7%) died and 12 of 87 patients (13.8%) transferred elsewhere. Thirty-seven of 87 patients (42.5%) were accepted for transfer of which 16 of 37 patients (43.2%) successfully transferred to our center with a median transfer waiting period of 12 days. Because of resource constraints, 21 of 37 accepted patients (56.8%) could not be transferred of which 9 of 21 patients (42.9%) died while waiting. Nine of 16 transferred patients (56.2%) eventually underwent lung transplantation with over 80% 6-month survival. ARDS patients referred for transplantation have high risk of mortality and, therefore, require well-described pathways for evaluation and transfer.

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