Early postoperative management after lung transplantation: Results of an international survey

King, Christopher S.; Valentine, Vincent G.; Cattamanchi, Ashok; Franco-Palacios, Domingo; Shlobin, Oksana A.; Brown, Anne; Singh, Ramesh; Bogar, Linda; Nathan, Steven D.

doi:10.1111/ctr.12985

Cited by 8 publications

(10 citation statements)

References 29 publications

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“…11 However, despite the critical role of mechanical ventilation in lung transplantation, very few data are available in the literature to guide clinical practice. 9,12–16 Thus, the currently applied protective mechanical ventilation strategies in lung transplantation patients have been extrapolated from the management of ARDS patients, 17–20 as the benefits of lung-protective mechanical ventilation extend to both patients with ARDS and patients at risk for ARDS. 16…”

Section: Postoperative Management Of Lung Transplantation Recipientsmentioning

confidence: 99%

Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit

et al. 2021

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The number of lung transplantations is progressively increasing worldwide, providing new challenges to interprofessional teams and the intensive care units. The outcome of lung transplantation recipients is critically affected by a complex interplay of particular pathophysiologic conditions and risk factors, knowledge of which is fundamental to appropriately manage these patients during the early postoperative course. As high-grade evidence-based guidelines are not available, the authors aimed to provide an updated review of the postoperative management of lung transplantation recipients in the intensive care unit, which addresses six main areas: (1) management of mechanical ventilation, (2) fluid and hemodynamic management, (3) immunosuppressive therapies, (4) prevention and management of neurologic complications, (5) antimicrobial therapy, and (6) management of nutritional support and abdominal complications. The integrated care provided by a dedicated multidisciplinary team is key to optimize the complex postoperative management of lung transplantation recipients in the intensive care unit.

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Section: Postoperative Management Of Lung Transplantation Recipientsmentioning

confidence: 99%

Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit

et al. 2021

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“…The goals of MV following lung transplantation are to promote graft function, maintain adequate gas exchange, and prevent ventilator-induced lung injury [ 7 ]. There have been no large, multicenter trials to guide MV management after lung transplantation despite the critical role of MV in lung transplantation, and only a few studies have addressed appropriate MV after lung transplantation [ 22 , 23 ]. Despite wide variation in practice, the currently applied lung protective MV strategies in lung transplantation have been extrapolated from the practice guideline for MV patients with acute respiratory distress syndrome (ARDS), since experimental data suggest that all lung transplantation recipients are at risk of ventilator-induced lung injury [ 24 ].…”

Section: Management Of Mechanical Ventilationmentioning

confidence: 99%

“…Therefore, individualized management is required to maintain adequate perfusion pressure balance with the lowest possible cardiac output to reduce the exacerbation of pulmonary edema risk. Postoperative volume status management is actually an area of considerable heterogeneity in practice [ 23 ]. The implementation of a dedicated protocol that maintains specific hemodynamic targets has been shown to be associated with reduced graft dysfunction severity [ 46 ].…”

Section: Management Of Hemodynamicsmentioning

confidence: 99%

Critical Care Management Following Lung Transplantation

Jeon

2022

J Chest Surg

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Postoperative critical care management for lung transplant recipients in the intensive care unit (ICU) has expanded in recent years due to its complexity and impact on clinical outcomes. The practical aspects of post-transplant critical care management, especially regarding ventilation and hemodynamic management during the early postoperative period in the ICU, are discussed in this brief review. Monitoring in the ICU provides information on the patient’s clinical status, diagnostic assessment of complications, and future management plans since lung transplantation involves unique pathophysiological conditions and risk factors for complications. After lung transplantation, the grafts should be appropriately ventilated with lung protective strategies to prevent ventilator-induced lung injury, as well as to promote graft function and maintain adequate gas exchange. Hypotension and varying degrees of pulmonary edema are common in the immediate postoperative lung transplantation setting. Ventricular dysfunction in lung transplant recipients should also be considered. Therefore, adequate volume and hemodynamic management with vasoactive agents based on their physiological effects and patient response are critical in the early postoperative lung transplantation period. Integrated management provided by a professional multidisciplinary team is essential for the critical care management of lung transplant recipients in the ICU.

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“…According to a recent multicenter survey, more than half of respondents answered that propofol in combination with opiates were preferred over other combinations, such as opiates with intermittent benzodiazepine. However, approximately 40% reported that there is no official drug policy on sedation and analgesia for the transplanted patient [38]. Recently, the use of dexmedetomidine, a selective alpha agonist, has been increasing in ICUs.…”

Section: Immediate Postoperative Management Of Lung Transplantationmentioning

confidence: 99%

Critical Care after Lung Transplantation

et al. 2018

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Since the first successful lung transplantation in 1983, there have been many advances in the field. Nevertheless, the latest data from the International Society for Heart and Lung Transplantation revealed that the risk of death from transplantation is 9%. Various aspects of postoperative management, including mechanical ventilation, could affect intensive care unit stay, hospital stay, and immediate postoperative morbidity and mortality. Complications such as reperfusion injury, graft rejection, infection, and dehiscence of anastomosis increase fatal adverse side effects immediately after surgery. In this article, we review the possible immediate complications after lung transplantation and summarize current knowledge on prevention and treatment.

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Early postoperative management after lung transplantation: Results of an international survey

Abstract: Practice patterns in the early postoperative care of lung transplant recipients differ considerably among centers. Many of the reported practices do not conform to consensus guidelines on management of critically ill patients.

Cited by 8 publications

References 29 publications

Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit

Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit

Critical Care Management Following Lung Transplantation

Critical Care after Lung Transplantation

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