title: Non-invasive ventilation in prone position for refractory hypoxemia after bilateral lung transplantation.
abstract: Temporary graft dysfunction with gas exchange abnormalities is a common finding during the postoperative course of a lung transplant and is often determined by the post-reimplantation syndrome. Supportive measures including oxygen by mask, inotropes, diuretics, and pulmonary vasodilators are usually effective in non-severe post-reimplantation syndromes. However, in less-responsive clinical pictures, tracheal intubation with positive pressure ventilation, or non-invasive positive pressure ventilation (NIV), is necessary. We report on the clinical course of two patients suffering from refractory hypoxemia due to post-reimplantation syndrome treated with NIV in the prone and Trendelenburg positions. NIV was well tolerated and led to resolution of atelectactic areas and dishomogeneous lung infiltrates. Repeated turning from supine to prone under non invasive ventilation determined a stable improvement of gas exchange and prevented a more invasive approach. Even though NIV in the prone position has not yet entered into clinical practice, it could be an interesting option to achieve a better match between ventilation and perfusion. This technique, which we successfully applied in lung transplantation, can be easily extended to other lung diseases with non-recruitable dorso-basal areas.
authors.affiliation: Department of Pharmacology and Anaesthesia, University Hospital of Padua, Padova, Italy. paolofeltracco@inwind.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Feltracco
authors.forename: Eugenio
authors.initials: E
authors.lastname: Serra
authors.forename: Stefania
authors.initials: S
authors.lastname: Barbieri
authors.forename: Paolo
authors.initials: P
authors.lastname: Persona
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
authors.forename: Monica
authors.initials: M
authors.lastname: Loy
authors.forename: Carlo
authors.initials: C
authors.lastname: Ori
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy*; D016040:Lung Transplantation; D008297:Male; D011175:Positive-Pressure Respiration; D011183:Postoperative Complications; D011379:Prognosis; D016684:Prone Position; D012119:Respiration