MECHANICAL VENTILATION FOR THE LUNG TRANSPLANT RECIPIENT.

Area of Science:

• Critical Care Medicine
• Pulmonary Medicine
• Transplant Surgery

Background:

• Mechanical ventilation (MV) is crucial for lung transplant (LTx) recipients during intraoperative and early postoperative periods.
• Primary graft dysfunction (PGD), a major early complication, shares similarities with acute respiratory distress syndrome (ARDS).
• Current LTx-MV strategies lack randomized controlled trials, relying on center experiences and surveys.

Purpose of the Study:

• To review and synthesize available data on mechanical ventilation in lung transplant recipients.
• To provide evidence-based recommendations for LTx-MV strategies, considering PGD and ARDS.
• To explore the role of donor versus recipient characteristics in guiding MV.

Main Methods:

• Literature review and synthesis of existing LTx center experiences and international survey data.
• Analysis of information on PGD, ARDS, and intraoperative MV relevant to LTx.
• Formulation of recommendations based on the gathered evidence.

Main Results:

• Lung-protective MV, characterized by low tidal volumes (≤6 mL/kg predicted body weight [PBW]) and positive end-expiratory pressure, is recommended.
• The proposed MV strategy emphasizes donor characteristics (e.g., donor PBW for allograft size) over recipient characteristics.
• This approach is based on indirect evidence and necessitates further prospective validation.

Conclusions:

• Lung-protective mechanical ventilation is recommended for lung transplant recipients.
• A donor-characteristics-based MV strategy may optimize allograft protection.
• Prospective studies are required to validate the efficacy of donor-characteristics-based protective MV in lung transplantation.