Mechanical ventilation post-bilateral lung transplantation: A scoping review

Area of Science:

• Critical Care Medicine
• Thoracic Surgery
• Respiratory Physiology

Background:

• Lung protective ventilation (LPV) for acute respiratory distress syndrome is often applied to lung transplant recipients.
• This approach may not account for unique respiratory failure and allograft physiology in lung transplant patients.

Purpose of the Study:

• To systematically review research on ventilation and physiological parameters post-bilateral lung transplantation.
• To identify associations with patient outcomes and knowledge gaps.

Main Methods:

• Comprehensive literature searches of MEDLINE, EMBASE, SCOPUS, and Cochrane Library (2000-2022).
• Inclusion of studies on immediate post-operative ventilation in bilateral lung transplant recipients.
• Exclusion of animal models, single-lung transplants, and ECMO-only cases.

Main Results:

• 11 studies included from 1212 screened; study quality was poor with no prospective multi-centre trials.
• Reported LPV parameters included tidal volume (82%), indexed tidal volume (27%), and plateau pressure (18%).
• Undersized grafts may face risks from unrecognised higher tidal volume ventilation indexed to donor body weight; graft dysfunction was a key outcome.

Conclusions:

• A significant knowledge gap exists regarding optimal ventilation strategies for lung transplant recipients.
• Uncertainty surrounds the safest ventilation practices, particularly for patients with high-grade primary graft dysfunction and undersized allografts.
• These patient subgroups require further investigation to define optimal care.