Postoperative Management of Hyperinflated Native Lung in Single-Lung Transplant Recipients with Chronic Obstructive Pulmonary Disease: A Review Article

Shehata, Islam Mohammad; Elhassan, Amir; Urits, Ivan; Viswanath, Omar; Seoane, Leonardo; Shappley, Courtney; Kaye, Alan D.

doi:10.1007/s41030-020-00141-6

Cited by 9 publications

(7 citation statements)

References 45 publications

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“…One-lung ventilation (OLV) is essential for many thoracic and several non-thoracic procedures such as spine fixation (12). One-lung ventilation is typically achieved by placing either a double-lumen ETT (DLT) or endobronchial blocker (EBB) via a conventional single-lumen endotracheal tube (13). The complications of DLT include malposition, increased airway resistance due to the narrower lumen, and airway injury.…”

Section: One Lung Ventilationmentioning

confidence: 99%

Challenge of Lung Isolation in Patients with Vocal Cord Implants

et al. 2022

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: Glottic closure insufficiency increases the risk of aspiration and pneumonia, particularly in the elderly. Medialization thyroplasty is an open surgical procedure for treating glottic incompetency by approximating both vocal folds. The vocal fold medialization is achieved by inserting an implant to bring the nonmobile fold to the unaffected side. Lung isolation in patients with vocal cord implantation poses a unique challenge. Understanding the risks of different modalities of lung isolation and their impacts on the vocal cord implant is crucial to implementing a specifically tailored plan. Preoperative bronchoscopy, intraoperative video laryngoscopy, and bronchoscopy are ideal methods for assessing the vocal fold implants and guiding the lung isolation technique. Bronchial blocker through a single-lumen endotracheal tube may be the preferred choice to avoid the injury of the stretched vocal cords and dislodgement of the implant by a larger diameter double-lumen tube.

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Section: One Lung Ventilationmentioning

confidence: 99%

Challenge of Lung Isolation in Patients with Vocal Cord Implants

et al. 2022

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“…Even though SLT has several benefits over bilateral LT, it is still a double-edged sword regarding the native lung, which remains one of the major causes of post-SLT complications[ 58 , 59 ].…”

Section: Native Lung Complicationsmentioning

confidence: 99%

“…Furthermore, Shehata et al [ 59 ] emphasized mechanical ventilation regimens intending to treat ANLH. They suggested that prophylactic noninvasive positive pressure ventilation was the first-choice treatment because it reduces the weaning time and risk of prolonged invasive mechanical ventilation.…”

Section: Native Lung Complicationsmentioning

confidence: 99%

Factors affecting complications development and mortality after single lung transplant

Sekulovski¹,

Simonska²,

Peruhova³

et al. 2021

WJT

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Lung transplantation (LT) is a life-saving therapeutic procedure that prolongs survival in patients with end-stage lung disease. Furthermore, as a therapeutic option for high-risk candidates, single LT (SLT) can be feasible because the immediate morbidity and mortality after transplantation are lower compared to sequential single (double) LT (SSLTx). Still, the long-term overall survival is, in general, better for SSLTx. Despite the great success over the years, the early post-SLT period remains a perilous time for these patients. Patients who undergo SLT are predisposed to evolving early or late postoperative complications. This review emphasizes factors leading to post-SLT complications in the early and late periods including primary graft dysfunction and chronic lung allograft dysfunction, native lung complications, anastomosis complications, infections, cardiovascular, gastrointestinal, renal, and metabolite complications, and their association with morbidity and mortality in these patients. Furthermore, we discuss the incidence of malignancy after SLT and their correlation with immunosuppression therapy.

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“…However, SLT often causes native lung hyperinflation (NLH), which may be induced by asymmetrical distribution of gas flow with air-trapping in the native lung due to the marked difference in compliance between the highly compliant native lung and restrictive donor lung (2,7). NLH is particularly prone to occur under positive-pressure mechanical ventilation and may be worsened by donor lung edema due to ischemic reperfusion injury, ventilator-induced lung injury or primary allograft dysfunction (8,9). NLH may cause mediastinum shift and extrinsic allograft compression, resulting in atelectasis, impaired gas exchange and hemodynamic instability, which may require specific ventilator strategies or lung volume reduction surgery (2,8,9).…”

Section: Introductionmentioning

confidence: 99%

“…NLH is particularly prone to occur under positive-pressure mechanical ventilation and may be worsened by donor lung edema due to ischemic reperfusion injury, ventilator-induced lung injury or primary allograft dysfunction (8,9). NLH may cause mediastinum shift and extrinsic allograft compression, resulting in atelectasis, impaired gas exchange and hemodynamic instability, which may require specific ventilator strategies or lung volume reduction surgery (2,8,9).…”

Section: Introductionmentioning

confidence: 99%

Independent lung ventilation for the management of acute allograft rejection after single-lung transplantation for end-stage emphysema

et al. 2022

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Background : We herein report the use of independent lung ventilation (ILV) for managing acute allograft rejection after single-lung transplantation (SLT) for end-stage emphysema. Case presentation : A 54-year-old woman was transferred to our hospital with severe hypoxemia and respiratory distress due to unilateral lung disease with diffuse alveolar damage in the right donor lung associated with acute allograft rejection and with hyperinflation of the left native lung due to emphysema. She was unresponsive to immunosuppressive medications and conventional ventilation strategies, so different ventilator settings for each lung were required. A double-lumen endotracheal tube (DLT) was inserted, and ILV was initiated. The right lung was ventilated with high positive end-expiratory pressure (PEEP), intended for lung recruitment, and the left lung was ventilated with lung protective strategies using a low tidal volume and low levels of PEEP to avoid hyperinflation. Two days later, her lung function was dramatically improved, and the DLT was replaced with a single-lumen endotracheal tube. Gas exchange was maintained, and she was successfully weaned from mechanical ventilation on intensive-care unit day 15. Conclusions : ILV appears to be effective and safe for managing acute allograft rejection after SLT for emphysema.

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Postoperative Management of Hyperinflated Native Lung in Single-Lung Transplant Recipients with Chronic Obstructive Pulmonary Disease: A Review Article

Cited by 9 publications

References 45 publications

Challenge of Lung Isolation in Patients with Vocal Cord Implants

Challenge of Lung Isolation in Patients with Vocal Cord Implants

Factors affecting complications development and mortality after single lung transplant

Independent lung ventilation for the management of acute allograft rejection after single-lung transplantation for end-stage emphysema

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