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Is very early extubation after lung transplantation feasible?
Giorgio Della Rocca1, Cecilia Coccia, Gabriella M Costa
1Department of Anesthesia, University of Udine, Udine, Italy. giorgio.dellarocca@dsc.univd.it
Objective:
To evaluate donor graft function, intraoperative blood consumption, and oxygenation and hemodynamic stability in patients undergoing lung transplantation.
Design:
Prospective pilot study.
Setting:
University hospital.
Participants:
Forty-three patients undergoing lung transplantation from January 1999 to June 2001.
Interventions:
Hemodynamic monitoring, early extubation, and noninvasive ventilation criteria.
Measurements And Main Results:
The 31 nonearly extubated patients showed a lower PaO(2)/fraction of inspired oxygen (F(I)O(2)), a higher mean pulmonary arterial pressure, extravascular lung-water index (EVLWI) and vasoactive drug support (norepinephrine), and more blood products consumption than 12 early extubated patients at the end of surgery. Seven of 12 early extubated patients did not show any signs of respiratory failure after tracheal extubation; they were alert and able to perform deep breathing exercise and coughing. In the other 5 patients, hypoxemia, hypercapnia, and an increase of respiratory rate >30 breaths/min were observed. The intermittent application of noninvasive pressure ventilation by face mask avoided endotracheal intubation.
Conclusion:
The use of a short-acting anesthetic drug, appropriate intraoperative extubation criteria, epidural analgesia, and postoperative noninvasive ventilation make early extubation of lung-transplanted patients possible and effective.