Anaesthesia for lung transplantation

Buckwell, E; Vickery, B; Sidebotham, David

doi:10.1016/j.bjae.2020.07.001

Cited by 5 publications

(7 citation statements)

References 22 publications

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“…Pre-existing intermediate and severe PAH and idiopathic pulmonary fibrosis are particular risk factors for the occurrence of RVF preoperatively [ 5 , 12 , 85 ]. Intraoperatively, echocardiographic signs of acute (on chronic) right ventricular strain and suprasystemic pulmonary arterial pressures are indicators that make right ventricular decompensation likely.…”

Section: Discussionmentioning

confidence: 99%

“…In the context of lung transplantation, the occurrence of various haemodynamic complications is possible. These include RVF, LVF, or left ventricular diastolic dysfunction and RI associated with reperfusion oedema, increased pulmonary vascular resistance, and sterile inflammation [ 6 , 12 , 15 ].…”

Section: Risk Stratificationmentioning

confidence: 99%

“…Thus, TOE has a decisive role in the context of lung transplantation. Even the examination of vascular anastomoses in the context of lung transplantation is possible and described in some case reports as relevant to therapy [ 12 ]. It is not surprising that TOE for lung transplantation is considered indispensable in the consensus-based recommendations for intraoperative management to assess haemodynamics [ 14 ].…”

Section: Strategymentioning

confidence: 99%

“…Inhaled nitric oxide (iNO) or prostacyclin are commonly used to reduce right ventricular afterload [ 12 ]. Intravenous sildenfil is also available as a therapeutic option [ 71 ].…”

Section: Strategymentioning

confidence: 99%

“…This is due to the diverse This review article therefore aims to summarise the current trends of non-mechanical and mechanical circulatory support (MCS) during lung transplantation in an accentuated manner and to reflect the current status of the respective evidence. Focusing on the exemplary but also frequent complications of right ventricular failure (RVF), impairment of left ventricular function (left ventricular failure (LVF)) and RI, the pathophysiology, frequency of occurrence, and known risk factors are first discussed [12,13]. This and possible therapeutic strategies will be discussed on the basis of data from the current literature and especially against the background of the international consensus recommendations for anaesthesiologic and intensive care management of lung transplantation published in 2021 [12,14].…”

Section: Risk Stratificationmentioning

confidence: 99%

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Intraoperative Circulatory Support in Lung Transplantation: Current Trend and Its Evidence

Starke

Dossow

Karsten

2022

Life

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Lung transplantation has a high risk of haemodynamic complications in a highly vulnerable patient population. The effects on the cardiovascular system of the various underlying end-stage lung diseases also contribute to this risk. Following a literature review and based on our own experience, this review article summarises the current trends and their evidence for intraoperative circulatory support in lung transplantation. Identifiable and partly modifiable risk factors are mentioned and corresponding strategies for treatment are discussed. The approach of first identifying risk factors and then developing an adjusted strategy is presented as the ERSAS (early risk stratification and strategy) concept. Typical haemodynamic complications discussed here include right ventricular failure, diastolic dysfunction caused by left ventricular deconditioning, and reperfusion injury to the transplanted lung. Pre- and intra-operatively detectable risk factors for the occurrence of haemodynamic complications are rare, and the therapeutic strategies applied differ considerably between centres. However, all the mentioned risk factors and treatment strategies can be integrated into clinical treatment algorithms and can influence patient outcome in terms of both mortality and morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Risk Stratificationmentioning

confidence: 99%

Section: Strategymentioning

confidence: 99%

“…Inhaled nitric oxide (iNO) or prostacyclin are commonly used to reduce right ventricular afterload [ 12 ]. Intravenous sildenfil is also available as a therapeutic option [ 71 ].…”

Section: Strategymentioning

confidence: 99%

Section: Risk Stratificationmentioning

confidence: 99%

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Intraoperative Circulatory Support in Lung Transplantation: Current Trend and Its Evidence

Starke

Dossow

Karsten

2022

Life

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Anästhesie bei organtransplantierten Patient:innen

Fiala,

Breitkopf,

Sinner

et al. 2023

Anaesthesiologie

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ZusammenfassungOrgantransplantierte Patient:innen, die sich einem operativen Eingriff unterziehen müssen, der nicht im Zusammenhang mit ihrer Transplantation steht, können die betreuenden Anästhesist:innen vor große Herausforderungen stellen. Einerseits gilt es, die Transplantatfunktion in der perioperativen Phase sorgfältig hinsichtlich des Auftretens einer etwaigen Abstoßungsreaktion zu überwachen. Andererseits müssen die laufende Immunsuppression ggf. bezüglich des Wirkstoffes und/oder des Applikationsweges den perioperativen Erfordernissen angepasst sowie das sich aus ihr ergebende erhöhte Infektionsrisiko und mögliche Nebenwirkungen (wie z. B. Myelosuppression, Nephrotoxizität, Beeinträchtigung der Wundheilung usw.) in das perioperative Behandlungskonzept integriert werden. Des Weiteren sind möglicherweise persistierende Komorbiditäten der Grunderkrankung sowie physiologische Spezifika infolge der Organtransplantation zu beachten. Hierbei kann auf die Expertise das jeweiligen Transplantationszentrums zurückgegriffen werden.

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