[Perioperative care in lung transplantation: report of 18 cases]

To evaluate monitoring and cares in the intensive care unit (ICU) after lung transplantation.

From September 2002 to April 2005, there were 18 cases of lung transplant recipients, who had suffered from emphysema (9 cases), pulmonary fibrosis (5 cases), silicosis (1 cases), bronchiectasis (1 case), pulmonary vascular leiomyoma (1 case), ventricular septal defect and Eisenmenger's syndrome (1 case), respectively. Operative procedures included 9 cases with left lung transplantation, 5 right lung transplantation, 1 case right single lung transplantation and ventricular septal defect repair, and 3 cases bilateral lung transplantations. All the patients received mechanical ventilation, immunosuppressive agents, antibacterial prophylaxis, and prevention of reperfusion injury in the ICU after operation. Preoperatively, echocardiography (ECHO), artery blood gas,and oxygenation index (partial pressure of oxygen in artery/fraction of inspired oxygen, PaO(2)/FiO(2)) were observed.

The average weaning time from the ventilator was (7.39+/-4.89) days. The average ICU stay time was (9.72+/-8.32) days. The systolic pulmonary artery pressure (Ppa, syst) was monitored with Swan-Ganz catheterization 1 week post transplant, and it was found to have decreased significantly from (48.94+/-14.45) mm Hg (1 mm Hg=0.133 kPa) to (39.59+/-7.45) mm Hg (P<0.05). At the same time, oxygenation index was improved from (263.89+/-82.09) mm Hg to (345.56+/-92.18) mm Hg (P<0.05), partial pressure of carbon dioxide in artery (PaCO(2)) was decreased from (63.29+/-22.56) mm Hg to (38.37+/-9.19) mm Hg (P<0.05). In hospital mortality (HM) was 16.7% (3/18 cases), and an early death was due to severe infection on the 30 th postoperative day in 1 patient and acute rejection on the 15 th postoperative day in another patient, and the other patient died due to pulmonary vein embolism on the 36 th day. Fifteen patients recovered quickly and discharged from the hospital. One patient was followed up for 32 months.

Lung transplantation remains the only hope for many patients with end stage pulmonary disease. It is important that the lung transplant team possesses a working knowledge of the treatment of common complications, the time of these complications mostly likely to occur and how best to treat them when they do arise, to ensure long-term survival and success.