[Single lung transplantation retrospective analysis of intraoperative cardiovascular problems].
BACKGROUND
Analysis of haemodynamic problems during single-lung transplantation and of methodologies employed for their treatment.


METHODS



METHODS
clinical retrospective study.


METHODS
General University Hospital.


METHODS
patients with irreversible lung disease, either parenchymal or vascular, undergoing single lung transplantation.


METHODS
recording of circulatory failure episodes and treatment with pharmacologic support or cardiopulmonary bypass. Modifications occurring during the study period with respect to drugs administered. Evaluation of the consequences of cardiopulmonary bypass on the postoperative outcome, namely on the duration of mechanical ventilation and length of stay in the intensive care unit.


RESULTS
During the last 9 years 69 single-lung transplantations have been performed. In 50% of cases a pharmacologic support has been employed; the drug association dobutamine/nitroprusside has been gradually replaced by the association norepinephrine/nitric oxide for the treatment of right ventricular failure. Twenty patients required cardiopulmonary bypass and this caused a significant increase of the duration of mechanical ventilation and length of stay in the intensive care unit.


CONCLUSIONS
Hemodynamic changes during lung transplantation are complex and often severe, leading to a clinical status of right ventricular failure, that sometime requires a mechanical circulatory support. The introduction of nitric oxide in clinical practice significantly contributed to the optimization of intraoperative cardiocirculatory profile of patients, leading to a reduction in the use of vasoactive drugs and cardiopulmonary bypass.
Ceriana
P
P
IRCCS Fondazione S. Maugeri Centro Medico di Pavia, Divisione di Pneumologia Riabilitativa, IRCCS Policlinico San Matteo, Pavia, Italy.
Maurelli
M
M
Bianchi
T
T
Veronesi
R
R
Cortis
G
G
Pagnin
A
A
D'Armini
A
A
De Amici
D
D
D000293:Adolescent; D000328:Adult; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012189:Retrospective Studies