Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit

Abstract

The number of lung transplantations is progressively increasing worldwide, providing new challenges to interprofessional teams and the intensive care units. The outcome of lung transplantation recipients is critically affected by a complex interplay of particular pathophysiologic conditions and risk factors, knowledge of which is fundamental to appropriately manage these patients during the early postoperative course. As high-grade evidence-based guidelines are not available, the authors aimed to provide an updated review of the postoperative management of lung transplantation recipients in the intensive care unit, which addresses six main areas: (1) management of mechanical ventilation, (2) fluid and hemodynamic management, (3) immunosuppressive therapies, (4) prevention and management of neurologic complications, (5) antimicrobial therapy, and (6) management of nutritional support and abdominal complications. The integrated care provided by a dedicated multidisciplinary team is key to optimize the complex postoperative management of lung transplantation recipients in the intensive care unit.

The Impact of New Treatments on Short- and MID-Term Outcomes in Bilateral Lung Transplant: A Propensity Score Study

“…The five-year survival rate for patients receiving LT is estimated to be around 60%, a lower rate than for all other solid organ transplants [ 1 , 2 ]. In fact, short and long-term outcomes after LT are critically affected by a complex interplay between donor and recipient-related conditions and risk factors.…”

“…Furthermore, the choice of the best immunosuppressive therapy after LT remains a matter of controversy [ 1 , 2 ]. A broad consensus exists about the use of a multidrug immunosuppressive therapy based on the association of corticosteroids, calcineurin inhibitors (usually cyclosporine or tacrolimus), cell cycle inhibitors, and (optionally) induction agents [ 1 , 13 , 14 ]. However, the question concerning which calcineurin inhibitor is best to administer is still under investigation [ 13 , 14 ].…”

“…However, the question concerning which calcineurin inhibitor is best to administer is still under investigation [ 13 , 14 ]. Tacrolimus seems to reduce the incidence of organ rejection, bronchiolitis obliterans syndrome, nephrotoxicity, new-onset diabetes and malignancy as compared to cyclosporine, but no significant differences have been reported about short- and mid-term survival [ 1 , 13 , 14 , 15 ].…”

Critical Care Management Following Lung Transplantation

“…Therefore, although it remains unclear how to best reduce the driving pressure as part of lung protective ventilation strategy in practice, driving pressure-guided ventilation has been proposed as another technique to reduce postoperative pulmonary complications and improve recovery in thoracic surgery patients [ 31 ]. However, the use of a high PEEP to reduce driving pressure is generally avoided due to its potential negative effects on the healing of bronchial anastomosis and alveolar overdistension in grafts [ 5 ].…”

“…However, the number of patients transplanted from intensive care units (ICUs) with mechanical respiratory support has steadily increased based on the allocation system according to medical urgency, technical improvements, and reports of beneficial outcomes [ 3 ]. Therefore, the need for critical care before and after lung transplantation has increased in recent years, along with the multidisciplinary team approach [ 4 , 5 ]. Furthermore, critical care issues are involved in the management of early postoperative complications, as well as the safe bridging of candidates by mechanical respiratory support.…”