Predictors of independent lung ventilation: An analysis of 170 single-lung transplantations

Pilcher, David; Auzinger, G.; Mitra, Biswadev; Tuxen, David V.; Salamonsen, Robert F.; Davies, Andrew R.; Williams, Trevor; Snell, Gregory I

doi:10.1016/j.jtcvs.2006.10.028

Cited by 9 publications

(11 citation statements)

References 28 publications

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“…Intra‐operative flexible bronchoscopy is also performed to inspect the bronchial anastomoses, and this would be repeated in the ICU if there are problems. Initial management consists of conventional pressure‐controlled mechanical ventilation, limitation of positive end expiratory pressure to 12–15 cm H 2 O, and maintenance of a negative fluid balance, aiming for a central venous pressure of 5–8 mmHg (9). Inhaled nitric oxide at 20–40 ppm is added if thought to be of benefit, i.e., raised pulmonary arterial pressures or a suspicion that the underlying pathology is primary graft failure owing to ischemic reperfusion injury.…”

Section: Methodsmentioning

confidence: 99%

Institution of extracorporeal membrane oxygenation late after lung transplantation – a futile exercise?

Marasco

Vale

Preovolos

et al. 2011

Clinical Transplantation

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The use of and indications for extracorporeal membrane oxygenation (ECMO) are expanding as its reliability improves with widely varying results reported. A retrospective review of 24 lung transplant recipients who required ECMO support postoperatively was performed with 13 patients requiring ECMO within the first 48 h ("early" group) and 11 requiring ECMO after seven d postoperatively ("late" group). The majority of early ECMO group had primary graft failure patients and the late ECMO group comprised patients with infection or non-specific graft failure. There were significant differences in outcomes between groups, with 10/13 in the early group and 4/11 in the late group successfully weaned from ECMO (p = 0.045). Six of the 13 patients in the early group and none of the late group survived to hospital discharge (p = 0.009). The late ECMO group had a much higher incidence of death owing to complications existing prior to institution of ECMO (essentially uncontrolled infection or organ failure). There were no differences in complications arising during ECMO between groups. Late institution of ECMO in lung transplant recipients for causes other than primary graft failure is associated with such poor survival that its use should be considered only in very select cases.

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Section: Methodsmentioning

confidence: 99%

Institution of extracorporeal membrane oxygenation late after lung transplantation – a futile exercise?

Marasco

Vale

Preovolos

et al. 2011

Clinical Transplantation

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“…The surgical technique used by our group has not undergone substantial changes since our program began in 1999, and is similar to the recently described [19] . Ventilation difficulties during the immediate postoperative period are critical in SL in emphysema [20] . Patients are routinely extubated in the surgery room, or within the following 6 h whenever possible.…”

Section: General Care Protocol For Lung Transplant Recipientsmentioning

confidence: 99%

Single-lung transplantation in emphysema: Retrospective study analyzing survival and waiting list mortality

Borro¹,

Delgado²,

Coll³

et al. 2016

WJT

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AIM:To performed remains a subject of debate and is the principal aim of the study. METHODS:This retrospective analysis included 73 patients with emphysema (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012). The outcomes of patients undergoing single-lung transplantation (SL) (n = 40) or double-lung transplant (DL) (n = 33) were compared in a Cox multivariate analysis to study the impact of the technique, postoperative complications and acute and chronic rejection on survival rates. Patients were selected for inclusion in the waiting list according to the International Society of Heart Lung Transplantation criteria. Pre and postoperative rehabilitation and prophylaxis, surgical technique and immunosuppressive treatment were similar in every patients. Lung transplantation waiting list information on a national level and retrospective data on emphysema patient survival transplanted in Spain during the study period, was obtained from the lung transplantation registry managed by the National Transplant Organization (ONT). RESULTS:Both groups were comparable in terms of gender and clinical characteristics. We found significant differences in the mean age between the groups, the DL patients being younger as expected from the inclusion criteria. Perioperative complications occurred in 27.6% SL vs 54% DL (P = 0.032). Excluding perioperative mortality, median survival was 65.3 mo for SL and 59.4 mo for DL (P = 0.96). Bronchiolitis obliterans and overall 5-year survival were similar in both groups. Bacterial Core tip: This is a retrospective and comparative study of 2 cohort of patients with advanced-stage emphysema who were performed uni or bilateral lung transplant. The results of this study support the realization of singlelung transplantation in most of the cases of emphysema because it is technically simpler, it has less risk of surgical sutures, and finally it has less immediate postoperative complications. Single and double lung transplantation has a similar long-term survival. Moreover, if a second transplant is needed in the long-term, the contralateral transplantation has the same initial transplant survival if the patient remains in a similar clinical situation. Survival Spanish national register does not show difference between the two techniques too, supporting the results of our relatively small series. This strategy of performing single lung transplantation in most of the cases of emphysema would encourage and enhance the use of donors thanks to the twining procedure, and would decrease mortality in the waiting list as shown in the National Transplant Organization patients analysed. Proper pre and postoperative prophylaxis and postoperative early extubation protocol is essential to achieve good results.Borro JM, Delgado M, Coll E, Pita S. Singlelung transplantation in emphysema: Retrospective study analyzing survival and waiting list mortality. World J Transplant 2016; 6(2): 347355 Available from:

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“…Should these parameters not be met, oxygen delivery to the cells will be inadequate, leading to anaerobic metabolism and potential multi-organ failure. One of the reasons for clinical ventilation/perfusion mismatch can be pulmonary pathology, leading to so called shunt [ 1 – 3 ], another is—patient positioning on the operating table [ 4 , 5 ]. While young and healthy subjects can cope this scenario due to the efficiency of their physiological reflexes, in medicine, many surgical procedures involve elderly and critically ill patients with significant health impairments [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Data concerning tidal volume distribution in the lateral decubitus position are inconsistent and vary between 30% to 39% for the dependent lung. Presently, the only way to equalise uneven gas distribution is independent lung ventilation using two ventilators [ 1 – 3 , 12 ]. Recently, a unique device has been invented and patented by Polish engineers.…”

Section: Introductionmentioning

confidence: 99%

“…Apart from allowing independent ventilation at a 1:1 ratio, it enables the division of the inspired volume in proportions of 2:1, 3:1 and 5:1 [ 14 – 16 ]. This capability provides a new perspective for treating intensive care unit patients with one-lung pathologies [ 3 ]. The second prospect for use is within general anaesthesia in the lateral decubitus position, especially in the surgical treatment of major concomitant diseases or involving the pathology of one lung.…”

Section: Introductionmentioning

confidence: 99%

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Successful 1:1 proportion ventilation with a unique device for independent lung ventilation using a double-lumen tube without complications in the supine and lateral decubitus positions. A pilot study

et al. 2017

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IntroductionAdequate blood oxygenation and ventilation/perfusion matching should be main goal of anaesthetic and intensive care management. At present, one of the methods of improving gas exchange restricted by ventilation/perfusion mismatching is independent ventilation with two ventilators. Recently, however, a unique device has been developed, enabling ventilation of independent lungs in 1:1, 2:1, 3:1, and 5:1 proportions. The main goal of the study was to evaluate the device’s utility, precision and impact on pulmonary mechanics. Secondly- to measure the gas distribution in supine and lateral decubitus position.Materials and methods69 patients who underwent elective thoracic surgery were eligible for the study. During general anaesthesia, after double lumen tube intubation, the aforementioned control system was placed between the anaesthetic machine and the patient. In the supine and lateral decubitus (left/right) positions, measurements of conventional and independent (1:1 proportion) ventilation were performed separately for each lung, including the following: tidal volume, peak pressure and dynamic compliance.ResultsOur results show that conventional ventilation using Robertshaw tube in the supine position directs 47% of the tidal volume to the left lung and 53% to the right lung. Furthermore, in the left lateral position, 44% is directed to the dependent lung and 56% to the non-dependent lung. In the right lateral position, 49% is directed to the dependent lung and 51% to the non-dependent lung. The control system positively affected non-dependent and dependent lung ventilation by delivering equal tidal volumes into both lungs with no adverse effects, regardless of patient's position.ConclusionsWe report that gas distribution is uneven during conventional ventilation using Robertshaw tube in the supine and lateral decubitus positions. However, this recently released control system enables precise and safe independent ventilation in the supine and the left and right lateral decubitus positions.

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Predictors of independent lung ventilation: An analysis of 170 single-lung transplantations

Cited by 9 publications

References 28 publications

Institution of extracorporeal membrane oxygenation late after lung transplantation – a futile exercise?

Institution of extracorporeal membrane oxygenation late after lung transplantation – a futile exercise?

Single-lung transplantation in emphysema: Retrospective study analyzing survival and waiting list mortality

Successful 1:1 proportion ventilation with a unique device for independent lung ventilation using a double-lumen tube without complications in the supine and lateral decubitus positions. A pilot study

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