Lung protective ventilation based on donor size is associated with a lower risk of severe primary graft dysfunction after lung transplantation

Tague, Laneshia K.; Bedair, Bahaa; Witt, Chad A.; Byers, Derek E.; Guillamet, Rodrigo Vazquez; Kulkarni, Hrishikesh S.; Alexander‐Brett, Jennifer; Nava, Ruben G.; Kreisel, Daniel; Trulock, Elbert P.; Gelman, Andrew E.; Hachem, Ramsey R.

doi:10.1016/j.healun.2021.06.016

Cited by 11 publications

(27 citation statements)

References 33 publications

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“…There were 3/11 studies that reported the association between tidal volume and PGD grade within the first 72 h 9,10,15 . Two of the studies identified no significant association 9,15 .…”

Section: Resultsmentioning

confidence: 99%

“…There were only 2/11 studies that included a measure of plateau pressure 10,19 . One study reported two measures of initial and maximal plateau pressure 10 . In the PGD grade 3 sub‐group, the median value for maximal plateau pressure (32 cmH 2 O [31–37]) was above the recommended safety limit (<30 cmH 2 O) in ARDS patients.…”

Section: Resultsmentioning

confidence: 99%

“…The positive‐end expiratory pressure (PEEP) was reported in 8/11 studies with a range from 5 to 12 cmH 2 O 9–15,18 . The method of PEEP selection was reported in 1/11 studies, which included initial PEEP selection based on a protocol 9 .…”

Section: Resultsmentioning

confidence: 99%

“…The association of size‐mismatch and worse outcomes after lung transplantation is well described 16,18,23 . Dezube et al demonstrated that undersized grafts were ventilated with higher tidal volumes/kg dPBW when compared with oversized grafts, and Tague et al demonstrated an association between size mismatch and the risk of PGD grade 3 that was attenuated by dLPV 10 . These findings are hypothesis generating and highlight a sub‐group of patients with undersized grafts in whom unrecognised high tidal volumes in mL/kg dPBW present a plausible mechanism for VILI.…”

Section: Discussionmentioning

confidence: 96%

“…This review did identify retrospective data that described associations between ventilation parameters and patient outcomes 10,12,15 . This is most notable in the context of donor‐recipient size mismatch combined with tidal volume selection based on dPBW 10 .…”

Section: Discussionmentioning

confidence: 99%

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Mechanical ventilation post‐bilateral lung transplantation: A scoping review

Morgan

Åneman

Nair

2023

Acta Anaesthesiol Scand

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Background: Evidence from lung protective ventilation (LPV) in the acute respiratory distress syndrome has commonly been applied to guide periprocedural ventilation in lung transplantation. However, this approach may not adequately consider the distinctive features of respiratory failure and allograft physiology in the lung transplant recipient.This scoping review was conducted to systematically map the research describing ventilation and relevant physiological parameters post-bilateral lung transplantation with the aim to identify any associations with patient outcomes and gaps in the current knowledge base.Methods: To identify relevant publications, comprehensive literature searches of electronic bibliographic databases were conducted with the guidance of an experienced librarian in MEDLINE, EMBASE, SCOPUS and the Cochrane Library. The search strategies were peer-reviewed using the PRESS (Peer Review of Electronic Search Strategies) checklist. The reference lists of all relevant review articles were surveyed.Publications were included in the review if they described relevant ventilation parameters in the immediate post-operative period, published between 2000 and 2022 and involved human subjects undergoing bilateral lung transplantation. Publications were excluded if they included animal models, only single-lung transplant recipients or only patients managed with extracorporeal membrane oxygenation.Results: A total of 1212 articles were screened, 27 were subject to full-text review and 11 were included in the analysis. The quality of the included studies was assessed to be poor with no prospective multi-centre randomised controlled trials.The frequency of reported retrospective LPV parameters was as follows: tidal volume (82%), tidal volume indexed to both donor and recipient body weight (27%) and plateau pressure (18%). Data suggest that undersized grafts are at risk of unrecognised higher tidal volume ventilation indexed to donor body weight. The most reported patient-centred outcome was graft dysfunction severity in the first 72 h.

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“…There were 3/11 studies that reported the association between tidal volume and PGD grade within the first 72 h 9,10,15 . Two of the studies identified no significant association 9,15 .…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%