title: Postoperative respiratory management in living donor lobar lung transplantation.
abstract: BACKGROUND
  We evaluated postoperative respiratory management of living donor lobar lung transplantation (LDLLT).
  
  
  METHODS
  Perioperative variables were reviewed in 21 patients who underwent LDLLT at our institution. Recipients were kept intubated for at least two d after LDLLT to maintain optimal expansion of the implanted lobes. Subsequently, if weaning from artificial ventilation could be tolerated, extubation was considered with the assistance of non-invasive ventilation (NIV). If this could not be tolerated, early tracheostomy was considered.
  
  
  RESULTS
  All 21 recipients were weaned from artificial ventilation. Twelve patients underwent tracheotomy 4.4 ± 1.8 d after LDLLT and were weaned from artificial ventilation 24.3 ± 17.0 d after LDLLT. Eleven patients were extubated 3.6 ± 1.7 d after LDLLT with NIV, but two of them were reintubated, and finally weaned from artificial ventilation via tracheostomy. Excluding these two patients, NIV was required for 3.8 ± 3.9 d after extubation. The early postoperative course was significantly eventful in patients with tracheostomies, and artificial ventilation, ventilatory support, and intensive care unit stays were longer. Twenty patients (95%) showed survival at 24.4 ± 13.4 months of follow-up.
  
  
  CONCLUSIONS
  Postoperative respiratory management with NIV and early tracheostomy were useful after LDLLT.
authors.affiliation: Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.
authors.forename: Fengshi
authors.initials: F
authors.lastname: Chen
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chin
authors.forename: Masaaki
authors.initials: M
authors.lastname: Sato
authors.forename: Akihiro
authors.initials: A
authors.lastname: Aoyama
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Murase
authors.forename: Masanori
authors.initials: M
authors.lastname: Azuma
authors.forename: Toru
authors.initials: T
authors.lastname: Bando
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019520:Living Donors; D008171:Lung Diseases / Q000401:mortality* / Q000628:therapy; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012121:Respiration, Artificial / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: complication; living donor lobar lung transplantation; non-invasive ventilation; postoperative care; tracheostomy