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Marczin N, de Waal EEC, Hopkins PMA, Mulligan MS, Simon A, Shaw AD, Van Raemdonck D, Neyrinck A, Gries CJ, Algotsson L, Szegedi L, von Dossow V. International consensus recommendations for anesthetic and intensive care management of lung transplantation. An EACTAIC, SCA, ISHLT, ESOT, ESTS, and AST approved document. J Heart Lung Transplant 2021; 40:1327-1348. [PMID: 34732281 DOI: 10.1016/j.healun.2021.07.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Nandor Marczin
- Harefield Hospital Royal Brompton and Harefield Hospitals, Imperial College London, London, United Kingdom, Semmelweis University, Budapest, Hungary.
| | | | | | | | - Andre Simon
- Harefield Hospital RBHT, London, United Kingdom
| | | | | | | | | | | | - Laszlo Szegedi
- Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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The role of intraoperative pulmonary arterial catheterization data in determining the need for extracorporeal membrane oxygenation in lung transplantation. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:480-486. [PMID: 35096445 PMCID: PMC8762920 DOI: 10.5606/tgkdc.dergisi.2021.20485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/20/2020] [Indexed: 11/21/2022]
Abstract
Background
This study aims to investigate predictive factors of identification of the need of patients for extracorporeal membrane oxygenation support during lung transplantation.
Methods
A total of 63 patients (49 males, 14 females, mean age: 44.9±14.4 years; range, 14 to 64 years) who underwent lung transplantation in our institution between December 2016 and December 2019 were retrospectively analyzed. Demographic characteristics and perioperative clinical data of patients were recorded. After induction and pulmonary artery catheterization, cardiac output, mean pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac index, pulmonary vascular resistance, systemic vascular resistance, and right atrial pressure were measured using the thermodilution technique.
Results
Thirty-three of the patients received extracorporeal membrane oxygenation support during surgery. The right atrial pressure (p<0.001), pulmonary capillary wedge pressure (p<0.002), mean pulmonary artery pressure (p<0.001), and pulmonary vascular resistance (p<0.001) were statistically significantly higher in the patients who required extracorporeal membrane oxygenation support intraoperatively. The systemic vascular resistance (p<0.032) was statistically significantly lower in the patients who required extracorporeal membrane oxygenation support intraoperatively. A mean pulmonary artery pressure of >39 mmHg (p<0.02) and a right atrial pressure of >12 mmHg (p<0.047) were independent risk factors for ECMO support intraoperatively during lung transplantation.
Conclusion
Predicting the need of intraoperative extracorporeal membrane oxygenation support is of utmost importance in timing the need for mechanical support, protecting the new graft from high mechanical ventilator pressures, and adequately maintaining hemodynamic stability.
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Anesthetic management in lung transplantation: Our single-center experience. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:191-200. [PMID: 34104513 PMCID: PMC8167475 DOI: 10.5606/tgkdc.dergisi.2021.9490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/16/2020] [Indexed: 11/25/2022]
Abstract
Background
In this study, we aimed to discuss our anesthesia management strategies, experiences, and outcomes in patients undergoing lung transplantation.
Methods
Between December 2016 and December 2018, a total of 53 patients (43 males, 10 females; mean age: 46.1±13 years; range, 14 to 64 years) undergoing lung transplantation in our center were included. The anesthesia technique, patients" characteristics, and perioperative clinical and follow-up data were recorded. The stage of lung disease was assessed using the New York Heart Association functional classification.
Results
Two patients underwent single lung transplantation, while 51 patients underwent double lung transplantation. Idiopathic pulmonary fibrosis was the most common indication in 41.5% of the patients. All patients had end-stage lung disease (Class IV) and 79% were oxygen-dependent. The extracorporeal membrane oxygenation support was given to 32 patients.
Conclusion
The anesthetic management of lung transplantation is challenging, either due to the deterioration of the recipient"s physical performance and the complexity of the surgical techniques used. In general, a kind of mechanical support may be needed and extracorporeal membrane oxygenation is the first choice in the majority of patients. A close communication should be maintained between the surgeons, perfusion technicians, and anesthesiologists to ensure an optimal multidisciplinary approach and to achieve successful outcomes.
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Parikh AN, Merritt TC, Carvajal HG, Shepard MS, Canter MW, Abarbanell AM, Eghtesady P, Nath DS. A comparison of cardiopulmonary bypass versus extracorporeal membrane oxygenation: Does intraoperative circulatory support strategy affect outcomes in pediatric lung transplantation? Clin Transplant 2021; 35:e14289. [PMID: 33714228 DOI: 10.1111/ctr.14289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Data on adult lung transplantation suggest perioperative benefits of intraoperative extracorporeal membrane oxygenation (ECMO) compared to cardiopulmonary bypass (CPB). Information regarding their pediatric counterparts, however, is limited. This study compares outcomes of intraoperative ECMO versus CPB in pediatric lung transplantation. METHODS We reviewed all pediatric lung transplants at our institution from 2014 to 2019 and compared those supported intraoperatively on ECMO (n = 13) versus CPB (n = 22), plus a conditional analysis excluding re-transplantations (ECMO [n = 13] versus CPB [n = 20]). We evaluated survival, surgical times, intraoperative transfusions, postoperative support, complications, and duration of hospitalization. RESULTS Total time on ECMO support was significantly less than that of CPB support (P = .018). Intraoperatively, the ECMO group required fewer transfusions of fresh-frozen plasma (8.9 [5.8-22.3] vs 16.6 [11.4-39.0] mL/kg, P = .049) and platelets (4.2 [0.0-6.7] vs 8.0 [3.5-14.0] mL/kg, P = .049). When excluding re-transplantations, patients on ECMO required fewer packed red blood cells intraoperatively (12.6 [2.1-30.7] vs 28.2 [14.0-54.0] mL/kg, P = .048). There were no differences in postoperative support requirements, complications, or mortality at one, six, and twelve months. CONCLUSIONS Intraoperative ECMO support during pediatric lung transplantation appears to decrease intraoperative transfusion requirements when compared to CPB. Data from additional institutions may strengthen these observations.
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Affiliation(s)
- Amisha N Parikh
- Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Taylor C Merritt
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine/St. Louis Children's Hospital, St. Louis, MO, USA
| | - Horacio G Carvajal
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine/St. Louis Children's Hospital, St. Louis, MO, USA
| | - Mark S Shepard
- The Heart Center, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Matthew W Canter
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine/St. Louis Children's Hospital, St. Louis, MO, USA
| | - Aaron M Abarbanell
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine/St. Louis Children's Hospital, St. Louis, MO, USA
| | - Pirooz Eghtesady
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine/St. Louis Children's Hospital, St. Louis, MO, USA
| | - Dilip S Nath
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis School of Medicine/St. Louis Children's Hospital, St. Louis, MO, USA
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Olsen JE, Auråen H, Durheim MT, Fiane AE, Holm AM. Predictors of long intensive care need after lung transplantation. Clin Transplant 2020; 35:e14152. [PMID: 33185913 DOI: 10.1111/ctr.14152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND While expected need for intensive care after lung transplantation (LTx) does not normally affect organ allocation, it would be useful to estimate whether intensive care capacity is limited. The aim of this study was to assess factors available before LTx to identify predictors of prolonged intensive care unit (ICU) length of stay (LOS) after LTx. METHODS All bilateral LTx recipients excluding re-transplantation and multi-organ transplantation at Oslo University Hospital from 2000 to 2013 were included (n = 277). Predictive factors for ICU LOS were identified using pre- and perioperative variables. RESULTS Univariate analyses showed that recipients with pulmonary arterial hypertension, young age, female gender, low body height, low pretransplant actual total lung capacity (aTLC), and recipients who received an oversized donor lung were at risk for long ICU LOS. Patients with emphysema had lower risk of long ICU LOS. In multivariate analyses, a lower aTLC (p < .001) and a higher mean pulmonary artery pressure (mPAP) (p = .004) predicted prolonged ICU LOS. CONCLUSIONS We found that small recipient lung volume and high mPAP were predictors for prolonged ICU LOS. Our observations may be useful in planning use of resources in LTx, particularly in times of limited intensive care resources.
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Affiliation(s)
- Jul Eirik Olsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Henrik Auråen
- Department of Gastroenterological Surgery, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Michael T Durheim
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Arnt E Fiane
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Are M Holm
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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Abstract
Anesthesia for lung transplantation is both a demand ing and rewarding experience. Success requires team- work, experience, knowledge of cardiorespiratory patho physiology and its anesthetic implications, appropriate use of noninvasive and invasive monitoring, and the ability to respond quickly and effectively to life- threatening perioperative events. Specific issues in clude management of a patient with end-stage lung and heart disease, lung isolation and one-lung ventilation, perioperative respiratory failure, pulmonary hyperten sion, and acute right ventricular failure. Recent ad vances include greater understanding of dynamic hyper inflation ("gas-trapping") during mechanical ventilation, perioperative use of inhaled nitric oxide and treatment of acute right ventricular failure. Successful anesthetic management leads to greater hemodynamic stability, improvement in gas exchange and a reduction in need for cardiopulmonary bypass, all of which should lead to improved patient outcome.
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Affiliation(s)
- Paul S. Myles
- Department of Anaesthesia and Pain Management, Alfred Hospital, Melbourne, Australia
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Abstract
Lung transplantation is the only therapeutic option for more than 3,000 individuals in the United States with end-stage lung disease. Innovations in anesthetic and surgical techniques have expanded the indications for lung transplantation. Presently, the major limiting factor in the number of lung transplantations that are performed is the availability of suitable donor organs. Lung transplantation includes a number of surgical procedures, including single-lung, double-lung, bilateral-sequential-single-lung, heart-lung, and lobar transplantation. Patients undergoing lung transplantation present a variety of challenges to the anesthesia team. Critical periods include induction of anesthesia, initiation of positive pressure ventilation, establishment and maintenance of one-lung ventilation, pulmonary artery clamping, pulmonary artery unclamping, and reperfusion of the transplanted lung. Pharmacologic advances have been an important factor in the continued development and success of lung transplantation. Newer immunosuppressive agents have improved the prevention and management of post-transplant rejection. Selective pulmonary vasodilators that are administered via inhalation affect the anesthetic management during the surgical procedure. Technologic advances in monitoring have also been valuable in lung transplantation. Transesophageal echocardiography is commonly used to evaluate intraoperative ventricular function. Continuous cardiac output, mixed venous oxygen saturation, continuous arterial blood gas monitoring, and the bispectral index have also been used to monitor the patient during lung transplantation. Anesthetic management of lung transplantation requires a thorough understanding of end-stage lung disease and pharmacologic and technical considerations that may not be applicable in any other part of anesthetic practice.
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Affiliation(s)
- Allen Miranda
- Department of Anesthesiology, University of Wisconsin Hospitals and Clinics, Madison, WI
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Geube MA, Perez-Protto SE, McGrath TL, Yang D, Sessler DI, Budev MM, Kurz A, McCurry KR, Duncan AE. Increased Intraoperative Fluid Administration Is Associated with Severe Primary Graft Dysfunction After Lung Transplantation. Anesth Analg 2016; 122:1081-8. [PMID: 26991618 DOI: 10.1213/ane.0000000000001163] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Severe primary graft dysfunction (PGD) is a major cause of early morbidity and mortality in patients after lung transplantation. The etiology and pathophysiology of PGD is not fully characterized and whether intraoperative fluid administration increases the risk for PGD remains unclear from previous studies. Therefore, we tested the hypothesis that increased total intraoperative fluid volume during lung transplantation is associated with the development of grade-3 PGD. METHODS This retrospective cohort analysis included patients who had lung transplantation at the Cleveland Clinic between January 2009 and June 2013. We used multivariable logistic regression with adjustment for donor, recipient, and perioperative confounding factors to examine the association between total intraoperative fluid administration and development of grade-3 PGD in the initial 72 postoperative hours. Secondary outcomes included time to initial extubation and intensive care unit length of stay. RESULTS Grade-3 PGD occurred in 123 of 494 patients (25%) who had lung transplantation. Patients with grade-3 PGD received a larger volume of intraoperative fluid (median 5.0 [3.8, 7.5] L) than those without grade-3 PGD (3.9 [2.8, 5.2] L). Each intraoperative liter of fluid increased the odds of grade-3 PGD by approximately 22% (adjusted odds ratio, 1.22; 95% confidence interval [CI], 1.12-1.34; P <0.001). The volume of transfused red blood cell concentrate was associated with grade-3 PGD (1.1 [0.0, 1.8] L for PGD-3 vs 0.4 [0.0, 1.1 for nongrade-3 PGD] L; adjusted odds ratio, 1.7; 95% CI, 1.08-2.7; P = 0.002). Increased fluid administration was associated with longer intensive care unit stay (adjusted hazard ratio, 0.92; 97.5% CI, 0.88-0.97; P < 0.001) but not with time to initial tracheal extubation (hazard ratio, 0.97; 97.5% CI, 0.93-1.02; P = 0.17). CONCLUSIONS Increased intraoperative fluid volume is associated with the most severe form of PGD after lung transplant surgery. Limiting fluid administration may reduce the risk for development of grade-3 PGD and thus improve early postoperative morbidity and mortality after lung transplantation.
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Affiliation(s)
- Mariya A Geube
- From the *Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, Ohio; †Department of Anesthesiology and Critical Care, Cleveland Clinic, Cleveland, Ohio; ‡Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, Ohio; §Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio; ‖Transplantation Center, Department of Pulmonology, Allergy and Critical Care, Cleveland Clinic, Cleveland, Ohio; ¶Departments of Outcomes Research and General Anesthesiology, Cleveland Clinic, Cleveland, Ohio; #Transplantation Center, Department of Thoracic and Cardiovascular Surgery and Department of Pathobiology, Cleveland Clinic, Cleveland, Ohio; and **Departments of Cardiothoracic Anesthesia and Outcomes Research, Cleveland Clinic, Cleveland Clinic, Cleveland, Ohio
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Mizota T, Matsukawa S, Fukagawa H, Daijo H, Tanaka T, Chen F, Date H, Fukuda K. The clinical course of anesthetic induction in lung transplant recipients with pulmonary complications after hematopoietic stem cell transplantation. J Anesth 2015; 29:562-9. [DOI: 10.1007/s00540-015-1986-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 02/04/2015] [Indexed: 12/24/2022]
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Myles PS. Lessons from lung transplantation for everyday thoracic anesthesia. ANESTHESIOLOGY CLINICS OF NORTH AMERICA 2001; 19:581-90, vii. [PMID: 11571907 DOI: 10.1016/s0889-8537(05)70248-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with end-stage lung disease are at significant risk of hypoxia and dynamic hyperinflation during mechanical ventilation, particularly during one-lung ventilation. This article describes aspects of care such as patients, including acceptance of permissive hypercapnia, adjustment of ventilator settings, and methods to optimize recovery from anesthesia.
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Affiliation(s)
- P S Myles
- Department of Anaesthesia and Pain Management, Alfred Hospital, Australia.
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11
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Rocca GD, Coccia C, Pompei L, Ruberto F, Venuta F, De Giacomo T, Pietropaoli P. Hemodynamic and oxygenation changes of combined therapy with inhaled nitric oxide and inhaled aerosolized prostacyclin. J Cardiothorac Vasc Anesth 2001; 15:224-7. [PMID: 11312484 DOI: 10.1053/jcan.2001.21974] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate hemodynamic and oxygenation changes of combined therapy with inhaled nitric oxide (iNO) and inhaled aerosolized prostcyclin (IAP) during lung transplantation. DESIGN Prospective study. SETTING University hospital. PARTICIPANTS Ten patients scheduled for lung transplantation. INTERVENTIONS Ten patients, with a mean age of 38 years (range, 24 to 56 years), were scheduled for lung transplantation (2 single-lung transplantations and 8 double-lung transplantations). During first lung implantation with single-lung perfusion and ventilation, hemodynamic and oxygenation data were analyzed in 3 phases: (1) baseline, 5 minutes after pulmonary artery clamping; (2) inhaled NO phase, 15 minutes after inhaled NO administration (20 ppm) in 100% oxygen; and (3) IAP-inhaled NO phase, 15 minutes after combined administration of inhaled NO (20 ppm) and IAP (10 ng/kg/min) in 100% oxygen. MEASUREMENTS AND MAIN RESULTS During the inhaled NO phase, reductions of mean pulmonary arterial pressure (p < 0.05) and intrapulmonary shunt (p < 0.05) were noted. After the start of prostacyclin inhalation, a further decrease in mean pulmonary arterial pressure (p < 0.05) was observed. PaO2/FIO2 increased during the IAP-inhaled NO phase (p < 0.05), whereas intrapulmonary shunt decreased (p < 0.05). CONCLUSION This study confirms the action of inhaled NO as a selective pulmonary vasodilator during lung transplantation. Combined therapy with IAP and inhaled NO increases the effects on pulmonary arterial pressure and oxygenation compared with inhaled NO administered alone without any systemic changes.
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Affiliation(s)
- G D Rocca
- Istituto di Anestesiologia e Rianimazione, Cattedra di Chirurgia Toracica, University of Rome "La Sapienza," Azienda Ospedaliera Policlinico Umberto I, Rome, Italy.
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Marczin N, Royston D, Yacoub M. Pro: lung transplantation should be routinely performed with cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2000; 14:739-45. [PMID: 11139121 DOI: 10.1053/jcan.2000.18592] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- N Marczin
- Department of Cardiothoracic Surgery and Anaesthetics, National Heart and Lung Institute, Imperial College of Science Technology and Medicine, Harefield Hospital, United Kingdom
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McRae K. Con: lung transplantation should not be routinely performed with cardiopulmonary bypass. J Cardiothorac Vasc Anesth 2000; 14:746-50. [PMID: 11139122 DOI: 10.1053/jcan.2000.18601] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- K McRae
- Department of Anaesthesia, The Toronto General Hospital, University Health Network, Ontario, Canada
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Abstract
Anesthetic technique for pulmonary transplantation varies with recipient's underlying lung disease, procedure performed and regional practice. The pulmonary allograft is vulnerable to mechanical and biochemical injury throughout the harvesting, preservation and engraftment procedures. Mechanisms of allograft injury are reviewed, with suggestions for incorporation of strategies to minimize injury into clinical practice. Particular emphasis is placed on the use of nitric oxide for treatment of reperfusion injury.
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Affiliation(s)
- K M McRae
- Department of Anaesthesia, Toronto General Hospital, Toronto, Ontario, Canada.
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Myles PS, Buckland MR, Weeks AM, Bujor M, Moloney J. Continuous arterial blood gas monitoring during bilateral sequential lung transplantation. J Cardiothorac Vasc Anesth 1999; 13:253-7. [PMID: 10392673 DOI: 10.1016/s1053-0770(99)90259-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the accuracy and clinical utility of a continuous arterial blood gas (ABG) monitor during lung transplantation. DESIGN Prospective, observational cohort study. SETTING University hospital. PARTICIPANTS Eleven patients undergoing bilateral sequential lung transplantation (BSLTx). INTERVENTIONS Repeated ABG sampling. MEASUREMENTS AND MAIN RESULTS Agreement was measured by the bias (limits of agreement): pH, 0.006 (-0.10 to 0.10); PaO2, -22 mmHg (-130 to 86 mmHg); and PaCO2, -1.6 mmHg (-13.4 to 10.2 mmHg). Sensitivity and specificity of the Paratrend 7 (Biomedical Sensors, Ltd, Malvern, PA) PaO2 measurements (to detect PaO2 < 100 mmHg) were 84.6% and 97.6%, respectively. CONCLUSION Continuous ABG monitoring with the Paratrend 7 shows sufficiently good agreement with laboratory blood gas analysis during BSLTx and thus is a convenient alternative to intermittent laboratory blood gas measurement. Because of the potential for significant (and sometimes rapid) acid-base disturbances, continuous ABG monitoring may have a role during most lung transplantation procedures.
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Affiliation(s)
- P S Myles
- Department of Anaesthesia and Pain Management, Alfred Hospital, Melbourne, Australia
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Westerlind A, Nilsson F, Ricksten SE. The use of continuous positive airway pressure by face mask and thoracic epidural analgesia after lung transplantation. Gothenburg Lung Transplant Group. J Cardiothorac Vasc Anesth 1999; 13:249-52. [PMID: 10392672 DOI: 10.1016/s1053-0770(99)90258-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the clinical use of continuous positive airway pressure (CPAP) and thoracic epidural analgesia (TEA) after lung transplantation (LTx). DESIGN Retrospective case series. SETTING Cardiothoracic intensive care unit (ICU) at a university hospital. PARTICIPANTS All heart-lung, bilateral, and single-lung transplant recipients between 1990 and 1996 at this institution (n = 102). INTERVENTIONS Postoperative pain was controlled by a thoracic epidural infusion of bupivacaine, 1 mg/mL, and sufentanil, 1 microg/mL. After extubation, CPAP, 5 to 10 cm H2O by face mask, was used to prevent reperfusion edema. MEASUREMENTS AND MAIN RESULTS In 99 patients, the length of ventilation (LOV) was a median of 4.3 hours (range, 1.0 to 312.0 hours). The median LOV was 8.0 hours (range, 1.5 to 41.0 hours) in the heart-lung recipients, 4.5 hours (range, 2.0 to 47.0 hours) in the bilateral-lung recipients, and 3.5 hours (range, 1.0 to 312.0 hours) in the single-lung recipients. Three transplant recipients, all with primary pulmonary hypertension, were prematurely extubated and reintubated because of pulmonary edema. Twelve hours after extubation, the median oxygenation index (PaO2/F(I)O2, PaO2 in kilopascal units) was greater than 35. The median ICU length of stay for all transplant recipients was 4 days (range, 2 to 270 days). CONCLUSION The postoperative use of CPAP and TEA is associated with early and safe tracheal extubation after LTx and may shorten ICU stay.
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Affiliation(s)
- A Westerlind
- Department of Cardiothoracic Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Göteborg, Sweden
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