Risk factors and clinical consequences of early extubation failure in lung transplant recipients

Background Prolonged intubation following lung transplantation is thought to delay recovery, yet a paucity of data exists regarding risk factors and outcomes related to extubation failure.Methods We performed a single-center, retrospective analysis of 238 lung transplant recipients between January 1, 2018, and December 31, 2022, to identify risk factors for extubation failure (intubation greater than 3 days, reintubation, and/or need for tracheostomy). We also assessed short-term outcomes relative to extubation success.Results In this cohort, 144 patients (60%) were extubated successfully while 94 patients experienced extubation failure; 10 (11%) were intubated greater than 3 days, 9 (9%) were reintubated, 34 (36%) required tracheostomy after reintubation, and 41 (44%) underwent empiric tracheostomy. Recipient height and female sex, lung allocation score, 6-minute walk distance, donor ischemic time, ex-vivo perfusion, donor smoking history, intraoperative transfused red blood cells (packed red blood cells (PRBCs)), primary graft dysfunction at time zero, and comatose sedation state at day 2 were associated with extubation failure on univariate analysis (all p p p p p Conclusions Specific baseline donor and recipient demographics and intraoperative variables are associated with greater risk for post-transplant extubation failure. Patients with extubation failure have worse short-term outcomes.