Is very early extubation after lung transplantation feasible?
OBJECTIVE
To evaluate donor graft function, intraoperative blood consumption, and oxygenation and hemodynamic stability in patients undergoing lung transplantation.


METHODS
Prospective pilot study.


METHODS
University hospital.


METHODS
Forty-three patients undergoing lung transplantation from January 1999 to June 2001.


METHODS
Hemodynamic monitoring, early extubation, and noninvasive ventilation criteria.


RESULTS
The 31 nonearly extubated patients showed a lower PaO(2)/fraction of inspired oxygen (F(I)O(2)), a higher mean pulmonary arterial pressure, extravascular lung-water index (EVLWI) and vasoactive drug support (norepinephrine), and more blood products consumption than 12 early extubated patients at the end of surgery. Seven of 12 early extubated patients did not show any signs of respiratory failure after tracheal extubation; they were alert and able to perform deep breathing exercise and coughing. In the other 5 patients, hypoxemia, hypercapnia, and an increase of respiratory rate >30 breaths/min were observed. The intermittent application of noninvasive pressure ventilation by face mask avoided endotracheal intubation.


CONCLUSIONS
The use of a short-acting anesthetic drug, appropriate intraoperative extubation criteria, epidural analgesia, and postoperative noninvasive ventilation make early extubation of lung-transplanted patients possible and effective.
Rocca
Giorgio Della
GD
Department of Anesthesia, University of Udine, Udine, Italy. giorgio.dellarocca@dsc.univd.it
Coccia
Cecilia
C
Costa
Gabriella M
GM
Pompei
Livia
L
Di Marco
Pierangelo
P
Pierconti
Federico
F
Cappa
Mila
M
Venuta
Frederico
F
Pietropaoli
Paolo
P
D000328:Adult; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004280:Dobutamine / Q000627:therapeutic use; D015633:Extravascular Lung Water / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007442:Intubation, Intratracheal; D008171:Lung Diseases / Q000601:surgery*; D016040:Lung Transplantation; D016343:Monitoring, Intraoperative / Q000706:statistics & numerical data; D009638:Norepinephrine / Q000627:therapeutic use; D010100:Oxygen / Q000097:blood; D010865:Pilot Projects; D011446:Prospective Studies; D013997:Time Factors; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents / Q000627:therapeutic use; D015300:Ventilator Weaning / Q000706:statistics & numerical data*
D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D004280:Dobutamine; D010100:Oxygen; D009638:Norepinephrine