MECHANICAL VENTILATION FOR THE LUNG TRANSPLANT RECIPIENT.
Mechanical ventilation (MV) is an important aspect in the intraoperative and early postoperative management of lung transplant (LTx)-recipients. There are no randomized-controlled trials of LTx-recipient MV strategies; however there are LTx center experiences and international survey studies reported. The main early complication of LTx is primary graft dysfunction (PGD), which is similar to the adult respiratory distress syndrome (ARDS). We aim to summarize information pertinent to LTx-MV, as well as PGD, ARDS, and intraoperative MV and to synthesize these available data into recommendations. Based on the available evidence, we recommend lung-protective MV with low-tidal-volumes (≤6 mL/kg predicted body weight [PBW]) and positive end-expiratory pressure for the LTx-recipient. In our opinion, the MV strategy should be based on donor characteristics (donor PBW as a parameter of actual allograft size), rather than based on recipient characteristics; however this donor-characteristics-based protective MV is based on indirect evidence and requires validation in prospective clinical studies.
Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics.
Lindsey
L
Barnes
Division of Pulmonary and Critical Care Medicine, University of Maryland.
Robert M
RM
Reed
Department of Thoracic and Cardiovascular Surgery, University of Iowa Hospitals and Clinics.
Kalpaj R
KR
Parekh
Department of Thoracic and Cardiovascular Surgery, University of Iowa Hospitals and Clinics.
Jay K
JK
Bhama
Division of Allergy, Pulmonary and Critical Care Medicine, University of Pennsylvania.
Tahuanty
T
Pena
Department of Anesthesia, University of Iowa Hospitals and Clinics.
Srinivasan
S
Rajagopal
Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics.
Gregory A
GA
Schmidt
Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics.
Julia A
JA
Klesney-Tait
Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics.
Michael
M
Eberlein
Lung transplantation; acute respiratory distress syndrome; lung protective ventilation; mechanical ventilation; primary graft dysfunction; tidal volume; ventilator induced lung injury