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Published on: July 10, 2012
Postoperative respiratory management in living donor lobar lung transplantation
Fengshi Chen1, Kazuo Chin, Masaaki Sato
1Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.
Background:
We evaluated postoperative respiratory management of living donor lobar lung transplantation (LDLLT).
Methods:
Perioperative variables were reviewed in 21 patients who underwent LDLLT at our institution. Recipients were kept intubated for at least two d after LDLLT to maintain optimal expansion of the implanted lobes. Subsequently, if weaning from artificial ventilation could be tolerated, extubation was considered with the assistance of non-invasive ventilation (NIV). If this could not be tolerated, early tracheostomy was considered.
Results:
All 21 recipients were weaned from artificial ventilation. Twelve patients underwent tracheotomy 4.4 ± 1.8 d after LDLLT and were weaned from artificial ventilation 24.3 ± 17.0 d after LDLLT. Eleven patients were extubated 3.6 ± 1.7 d after LDLLT with NIV, but two of them were reintubated, and finally weaned from artificial ventilation via tracheostomy. Excluding these two patients, NIV was required for 3.8 ± 3.9 d after extubation. The early postoperative course was significantly eventful in patients with tracheostomies, and artificial ventilation, ventilatory support, and intensive care unit stays were longer. Twenty patients (95%) showed survival at 24.4 ± 13.4 months of follow-up.
Conclusions:
Postoperative respiratory management with NIV and early tracheostomy were useful after LDLLT.
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