Early extubation in operating room after single-lung transplantation: a single institutional experience

Abstract

Background: Early endotracheal extubation in operating room (E-OR) after lung transplantation is rarely reported worldwide. Herein, we aim to explore the feasibility and safety of E-OR after lung transplantation and demonstrate its potential benefits.Methods: This study is a single-center retrospective database analysis of 18 patients. All lung transplantation patients with E-OR attempted between June 2018 and September 2019 were included retrospectively. Perioperative variables, including ischemia time, total blood loss, blood lactic acid, the partial pressure of oxygen, partial pressure of oxygen/fraction of inspiration oxygen ratio, time of semi-open pulmonary artery occlusion clamp, extubation rate, and complications after E-OR, were analyzed. Data were compared using non-parametric tests and expressed as the median or number (percentage).Results: Clinical data of 18 patients with E-OR attempted were collected. Overall, 15/18 (83.33%) patients successfully underwent E-OR without reintubation. Reintubation occurred in 3/18 (16.67%) patients; one patient presented with decreased blood oxygen saturation and unconsciousness, while two patients developed hypoxemia and respiratory failure after E-OR. Extracorporeal membrane oxygenation (ECMO) was not used postoperatively. No grade 3 primary graft dysfunction was observed and all eighteen patients were alive 1 year after the transplant. No postoperative hemodialysis and tracheotomy occurred. The median length of stay in the intensive care unit (ICU) for E-OR patients was 120 hours, the median length of postoperative hospital stay was 19 days, and the median hospitalization cost was 35,577 USD.Conclusions: Early endotracheal extubation in operating room was feasible and did not delay postoperative recovery in these 18 lung transplantation recipients.

Whole-organ deceased donor tracheal allograft transplantation for the treatment of refractory tracheal stenosis: a case report

“…Adequate blood pressure was maintained via intermittent phenylephrine infusion, which has been proved safe in microvascular surgery [15] . A conservative transfusion threshold of Hgb > 8 g/dL was also used.…”

“…Our anesthetic approach borrowed from routinely employed management techniques in microvascular free flap reconstruction, including judicious intravenous fluid administration [12] and a focus on early extubation, which is not only important in head and neck free flap surgery [13] , but also important in lung transplantation where it decreases anastomotic injury and postoperative infections [14,15] . A total intravenous anesthetic was utilized to limit waste gases during endotracheal tube manipulation and to facilitate smooth emergence.…”