Protective Ventilation And Lung Transplantation Surgery

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Protective Ventilation in Lung Transplantation Surgery Providing anesthesia for lung transplantation (LT) is considered by many to be a major feat in cardiothoracic anesthesia. Some say it involves the most complex manipulation of cardiothoracic physiology, especially when cardiopulmonary bypass (CPB) is not used. Indications for LT include 4 primary diagnostic groupings of end-stage pulmonary disease: (1) obstructive lung disease (chronic obstructive pulmonary disease (COPD); (2) restrictive lung disease (idiopathic pulmonary fibrosis, sarcoidosis); (3) cystic fibrosis or immunodeficiency disorders; and (4) pulmonary vascular disease (idiopathic pulmonary arterial hypertension, Eisenmenger syndrome) (Atilio, Shaw & Grichnik, 2012). Traditionally, ventilation strategies for this population included tidal volumes of 8-12ml/kg to prevent atelectasis and zero PEEP to prevent a shunt of blood flow. This strategy proved to cause harm during the periorperative period. New evidence now shows that a reduction in tidal volume with added PEEP not only decreases atelectasis, but it also reduces pulmonary inflammatory response. This paper will highlight the elements of protective lung ventilation in the perioperative management of LT recipients and the implications for their anesthetic care. Patient Assessment Lung transplantation surgery is unpredictable and emergent. Therefore, the preoperative workup of transplant recipients must be thoroughly performed in advance with appropriate

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