Anesthetic Management of Lung Transplantation: Center Specific Practices and Geographical and Centers Size Differences

Gelzinis, Theresa A.

doi:10.1053/j.jvca.2017.08.007

Cited by 9 publications

(7 citation statements)

References 19 publications

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“…Greater use of ECMO to allow an unintubated patient to rehab in preparation for their lung transplant has the potential to bring patients to their surgery in better physiological shape (39). The use CO 2 devices like Novalung and Decap allow to sustain patients when ventilation is not effective enough to manage patients' severe hypercapnia in the presence of only mild to moderate hypoxemia.…”

Section: Discussionmentioning

confidence: 99%

“…Dopamine, epinephrine and norepinephrine are widely used as are dobutamine and milrinone (62). Vasopressin may be chosen in the setting of needing an increase in SVR without elevating the PVR to optimize RV perfusion without increasing afterload (39).…”

Section: Hemodynamic Managementmentioning

confidence: 99%

“…The perioperative management of lung transplantation impacts outcomes and has been shown to vary considerably between medical centers across the globe (39,52). A key aspect of this intraoperative management is the use of ECLS.…”

Section: Management Of Extracorporeal Circulation In Lung Transplantationmentioning

confidence: 99%

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Anesthetic considerations in lung transplantation: past, present and future

Murray¹,

Boisen²,

Fritz³

et al. 2021

J Thorac Dis

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Lung transplantation is a very complex surgical procedure with many implications for the anesthetic care of these patients. Comprehensive preoperative evaluation is an important component of the transplant evaluation as it informs many of the decisions made perioperatively to manage these complex patients effectively and appropriately. These decisions may involve pre-emptive actions like pre-habilitation and nutrition optimization of these patients before they arrive for their transplant procedure. Appropriate airway and ventilation management of these patients needs to be performed in a manner that provides an optimal operating conditions and protection from ventilatory injury of these fragile post-transplant lungs.Pain management can be challenging and should be managed in a multi-modal fashion with or without the use of an epidural catheter while recognizing the risk of neuraxial technique in patients who will possibly be systemically anticoagulated. Complex monitoring is required for these patients involving both invasive and non-invasive including the use of transesophageal echocardiography (TEE) and continuous cardiac output monitoring. Management of the patient's hemodynamics can be challenging and involves managing the systemic and pulmonary vascular systems. Some patients may require extra-corporeal lung support as a planned part of the procedure or as a rescue technique and centers need to be proficient in instituting and managing this sophisticated method of hemodynamic support.

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Section: Discussionmentioning

confidence: 99%

Section: Hemodynamic Managementmentioning

confidence: 99%

See 1 more Smart Citation

Anesthetic considerations in lung transplantation: past, present and future

Murray¹,

Boisen²,

Fritz³

et al. 2021

J Thorac Dis

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“…In clinical routine, large differences in the operative course can be observed in transplantations due to idiopathic fibrosis with pronounced right heart strain or end-stage chronic obstructive pulmonary disease (COPD) [ 5 ]. The analysis of existing databases is also quite difficult, as many centres follow completely different therapeutic strategies during surgery [ 18 ]. Hinske et al developed a score that showed very good predictive power for the need for unplanned mechanical circulatory support.…”

Section: Risk Stratificationmentioning

confidence: 99%

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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“…Although the approach to intraoperative lung transplant management varies considerably among centers across the world, the use of ECMO for intraoperative support is increasing as a result of favorable outcomes data. [11][12][13][14][15] Intraoperative ECMO results in improved systemic perfusion during orthotopic lung transplantation, potential attenuation of ischemic-reperfusion injury from avoidance of hyperperfusion in double sequential or lobar lung transplantation, improved surgical exposure, and reduced operative time. 2,3,13 The Medical University of Vienna routinely uses ECMO in almost all lung transplants due to data showing improved 1-, 3-, and 5-year survival compared with patients transplanted without ECMO (91% v 82%, 85% v 76%, and 80% v 74%, respectively, p = 0.041).…”

Section: Intraoperativementioning

confidence: 99%