title: Mechanical ventilation after lung transplantation.
abstract: BACKGROUND
  To explore the hypothesis that early ventilation strategies influence clinical outcomes in lung transplantation, we have examined our routine ventilation practices in terms of tidal volumes (Vt) and inflation pressures.
  
  
  METHODS
  A total of 124 bilateral lung transplants between 2010 and 2013 were retrospectively assigned to low (<6 mL/kg), medium (6-8 mL/kg), and high (>8 mL/kg) Vt groups based on ventilation characteristics during the first 6 hours after surgery. Those same 124 patients were also stratified to low-pressure (<25 cm H2O) and high-pressure (≥25 cm H2O) groups.
  
  
  RESULTS
  Eighty percent of patients were ventilated using pressure control mode. Low, medium, and high Vt were applied to 10%, 43%, and 47% of patients, respectively. After correcting for patients requiring extracorporeal support, there was no difference in short-term to midterm outcomes among the different Vt groups. Low inflation pressures were applied to 61% of patients, who had a shorter length of intensive care unit stay (5 vs 12 days; P = .012), higher forced expiratory volume in 1 second at 3 months (77.8% vs 60.3%; P < .001), and increased 6-month survival rate (95% vs 77%; P = .008).
  
  
  CONCLUSIONS
  Low Vt ventilation has not been fully adopted in our practice. Ventilation with higher inflation pressures, but not Vt, was significantly associated with poorer outcomes after lung transplantation.
authors.affiliation: The Royal Brompton and Harefield NHS Foundation Trust, London, UK. Electronic address: louit@doctors.net.uk.
authors.forename: Louit
authors.initials: L
authors.lastname: Thakuria
authors.affiliation: The Royal Brompton and Harefield NHS Foundation Trust, London, UK.
authors.forename: Rosada
authors.initials: R
authors.lastname: Davey
authors.affiliation: The Royal Brompton and Harefield NHS Foundation Trust, London, UK; Section of Anaesthesia, Pain Medicine, and Intensive Care, Imperial College London, London, UK.
authors.forename: Rosalba
authors.initials: R
authors.lastname: Romano
authors.affiliation: The Royal Brompton and Harefield NHS Foundation Trust, London, UK.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Carby
authors.affiliation: The Royal Brompton and Harefield NHS Foundation Trust, London, UK.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Kaul
authors.affiliation: The Royal Brompton and Harefield NHS Foundation Trust, London, UK.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Griffiths
authors.affiliation: The Royal Brompton and Harefield NHS Foundation Trust, London, UK.
authors.forename: André R
authors.initials: AR
authors.lastname: Simon
authors.affiliation: The Royal Brompton and Harefield NHS Foundation Trust, London, UK.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Reed
authors.affiliation: The Royal Brompton and Harefield NHS Foundation Trust, London, UK; Section of Anaesthesia, Pain Medicine, and Intensive Care, Imperial College London, London, UK; Semmelweis University, Budapest, Hungary.
authors.forename: Nandor
authors.initials: N
authors.lastname: Marczin
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D013990:Tidal Volume
keywords: Lung transplantation; Mechanical ventilation