Prone positioning as a bridge to recovery from refractory hypoxaemia following lung transplantation†

Riera, Jordi; Maldonado, Carmen; Mazo, Cristopher; Martínez, María Paz; Baldirà, Jaume; Lagunes, Leonel; Augustín, Salvador; Román, Antonio; Due, Maria; Rello, Jordi; Levine, Deborah J.

doi:10.1093/icvts/ivx073

Cited by 12 publications

(14 citation statements)

References 18 publications

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“…6 The application of prone positioning has also been described as a rescue treatment to improve oxygenation in 22 lung transplantation recipients with refractory hypoxemia. 35 This is challenging to do in an acute postoperative patient, and further investigations are required to support its use in severe primary graft dysfunction.…”

Section: Review Articlementioning

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: Review Articlementioning

confidence: 99%

Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit

et al. 2021

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“…P : F ratio was specifically reported in 7/11 studies 11–15,17,18 . None of these studies reported the conditions (FiO 2 and PEEP) under which the P : F ratio was determined nor any correlation with calculated shunt fraction.…”

Section: Resultsmentioning

confidence: 99%

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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“…During this process, patients may experience adverse events such as unplanned catheter removal, wound dehiscence, and wound bleeding, especially in the early stage after cardiothoracic surgery (17), and major thoracic surgery has been considered a contraindication for the prone position. However, a recent single-center nonrandomized trial showed that in the early stage after lung transplantation, the prone position was safe and could significantly improve gas exchange in patients with postoperative refractory hypoxemia (18), and the trial showed no complications by using prone positioning On postoperative day 7, the patient received airway clearance therapy with a high-frequency oscillator to increase the expiratory flow and improve the clearance rate of airway secretions. Esguerra-Gonzales et al (19) found that in patients after lung transplantation, airway clearance therapy 4 times a day helps improve peak expiratory flow, the dyspnea score, and oxygen saturation.…”

Section: Case Presentationmentioning

confidence: 99%

Early rehabilitation after lung transplantation with extracorporeal membrane oxygenation (ECMO) of COVID-19 patient: a case report

et al. 2021

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Even when severe acute respiratory syndrome coronavirus 2-related coronavirus disease 2019 is treated with first-line drugs, it progresses and leads to irreversible loss of lung function in some critically ill patients, and lung transplantation is an effective treatment for end-stage chronic pulmonary disease. This case report mainly describes the rehabilitation of a 66-year-old female patient with severe COVID-19 after bilateral lung transplantation. The old patient had a body mass index of 31.2 kg/m 2 . She underwent bilateral lung transplantation due to severe and irreversible injury of both lungs.Long-term mechanical ventilation and extracorporeal membrane oxygenation (ECMO) treatment and preoperative and postoperative high-dose corticosteroid therapy and due to the size of the donor lung does not match the size of the recipient's diseased lung, and the right middle lobe of the graft is removed before transplantation. Weaning from the ventilator failed due to weak neuromuscular drive, and muscle strength.A full, personalized pulmonary rehabilitation program was initiated with the help of the physical therapists, the respiratory therapy, the doctors, the nurses and psychotherapist team based on the functional levels. The rehabilitation intervention was conducted on postoperative day 4, This included posture management, airway clearance techniques, respiratory training, muscle strength training, transfer training, daily therapeutic bronchoscopy and psychological support. The ECMO was removed successfully on the fifth day. the patient's physical function, muscle strength and the quality of life has been improved. The good prognosis after rehabilitation indicates that early rehabilitation intervention is effective and feasible and safety for patients after lung transplantation.

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Prone positioning as a bridge to recovery from refractory hypoxaemia following lung transplantation†

Abstract: Prone positioning is safe and significantly improves gas exchange in patients with refractory hypoxaemia after lung transplantation. It should be considered as a possible treatment in these patients.

Cited by 12 publications

References 18 publications

Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit

Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit

Mechanical ventilation post‐bilateral lung transplantation: A scoping review

Early rehabilitation after lung transplantation with extracorporeal membrane oxygenation (ECMO) of COVID-19 patient: a case report

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