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Browsing by Author "Björkbom, Emil"

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  • Björkbom, Emil (2016)
    BACKGROUND: Approximately 10-25 lung transplantations are performed annually in Finland, and one-year survival has been 95 % the last 10 years. 1-3 Our aim was to find associations between perioperative fluid replacement therapy and postoperative patient outcome, with special emphasis on the use of colloids and blood products. MATERIAL AND METHODS: We retrospectively evaluated data from 100 patients who underwent lung transplantation with cardiopulmonary by-pass support in Finland from 2007 to 2013. Outcomes of interest were length of stay in the intensive care unit, hospital stay time, time in ventilator, use of extracorporeal membrane oxygenation (ECMO) postoperatively, postoperative renal replacement therapy, postoperative graft failure, and one-year mortality. RESULTS: 100 patients were studied. 12 patients were on ECMO preoperatively. One-year mortality was 5/100 (5 %) and three-year mortality was 7/100 (7 %). Intraoperative fluid balance was positive (4762±3018 ml), but fell significantly postoperatively, being below +1000 ml on the first postoperative day. During the 2-7 postoperative days net fluid balance continued decreasing and stayed negative. Intraoperative use of hydroxyethyl starch and fresh frozen plasma were significantly higher in non-survived patients than in survivors, p<0.05. Intraoperative use of fresh frozen plasma, but not red blood cells or platelet concentrates, correlated with graft failure, p=0.012. The postoperative use of colloids or blood products did not correlate with mortality or graft failure. Patients who were on ECMO preoperatively, stayed longer on ventilator and their length of stay in the intensive care unit and the hospital ward were longer, p<0.001. 8 patients needed postoperative renal replacement therapy. CONCLUSIONS: Intraoperative use of fresh frozen plasma and hydroxyethyl starch is associated with increased mortality and graft failure. Postoperative use of colloids and red blood cells did not correlate with patients' outcome. Use of ECMO preoperatively resulted in prolonged length of stay.