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The role of mechanical ventilation in primary graft dysfunction in the postoperative lung transplant recipient : A single center study and literature review

Niroomand, Anna LU ; Qvarnström, Sara ; Stenlo, Martin LU ; Malmsjö, Malin LU orcid ; Ingemansson, Richard LU ; Hyllén, Snejana LU and Lindstedt, Sandra LU (2022) In Acta Anaesthesiologica Scandinavica 66(4). p.483-496
Abstract

Background: Primary graft dysfunction (PGD) is still a major complication in patients undergoing lung transplantation (LTx). Much is unknown about the effect of postoperative mechanical ventilation on outcomes, with debate on the best approach to ventilation. Aim/Purpose: The goal of this study was to generate hypotheses on the association between postoperative mechanical ventilation settings and allograft size matching in PGD development. Method: This is a retrospective study of LTx patients between September 2011 and September 2018 (n = 116). PGD was assessed according to the International Society of Heart and Lung Transplantation (ISHLT) criteria. Data were collected from medical records, including chest x-ray assessments, blood gas... (More)

Background: Primary graft dysfunction (PGD) is still a major complication in patients undergoing lung transplantation (LTx). Much is unknown about the effect of postoperative mechanical ventilation on outcomes, with debate on the best approach to ventilation. Aim/Purpose: The goal of this study was to generate hypotheses on the association between postoperative mechanical ventilation settings and allograft size matching in PGD development. Method: This is a retrospective study of LTx patients between September 2011 and September 2018 (n = 116). PGD was assessed according to the International Society of Heart and Lung Transplantation (ISHLT) criteria. Data were collected from medical records, including chest x-ray assessments, blood gas analysis, mechanical ventilator parameters and spirometry. Results: Positive end-expiratory pressures (PEEP) of 5 cm H2O were correlated with lower rates of grade 3 PGD. Graft size was important as tidal volumes calculated according to the recipient yielded greater rates of PGD when low volumes were used, a correlation that was lost when donor metrics were used. Conclusion: Our results highlight a need for greater investigation of the role donor characteristics play in determining post-operative ventilation of a lung transplant recipient. The mechanical ventilation settings on postoperative LTx recipients may have an implication for the development of acute graft dysfunction. Severe PGD was associated with the use of a PEEP higher than 5 and lower tidal volumes and oversized lungs were associated with lower long-term mortality. Lack of association between ventilatory settings and survival may point to the importance of other variables than ventilation in the development of PGD.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
lung transplant recipients, postoperative mechanical ventilation, primary graft dysfunction, protective lung ventilation
in
Acta Anaesthesiologica Scandinavica
volume
66
issue
4
pages
14 pages
publisher
Blackwell Munksgaard
external identifiers
  • pmid:35014027
  • scopus:85123684727
ISSN
0001-5172
DOI
10.1111/aas.14025
language
English
LU publication?
yes
id
170e36f2-9b80-4737-a01b-0be87cf5a62a
date added to LUP
2022-04-07 15:12:27
date last changed
2025-03-15 12:05:36
@article{170e36f2-9b80-4737-a01b-0be87cf5a62a,
  abstract     = {{<p>Background: Primary graft dysfunction (PGD) is still a major complication in patients undergoing lung transplantation (LTx). Much is unknown about the effect of postoperative mechanical ventilation on outcomes, with debate on the best approach to ventilation. Aim/Purpose: The goal of this study was to generate hypotheses on the association between postoperative mechanical ventilation settings and allograft size matching in PGD development. Method: This is a retrospective study of LTx patients between September 2011 and September 2018 (n = 116). PGD was assessed according to the International Society of Heart and Lung Transplantation (ISHLT) criteria. Data were collected from medical records, including chest x-ray assessments, blood gas analysis, mechanical ventilator parameters and spirometry. Results: Positive end-expiratory pressures (PEEP) of 5 cm H<sub>2</sub>O were correlated with lower rates of grade 3 PGD. Graft size was important as tidal volumes calculated according to the recipient yielded greater rates of PGD when low volumes were used, a correlation that was lost when donor metrics were used. Conclusion: Our results highlight a need for greater investigation of the role donor characteristics play in determining post-operative ventilation of a lung transplant recipient. The mechanical ventilation settings on postoperative LTx recipients may have an implication for the development of acute graft dysfunction. Severe PGD was associated with the use of a PEEP higher than 5 and lower tidal volumes and oversized lungs were associated with lower long-term mortality. Lack of association between ventilatory settings and survival may point to the importance of other variables than ventilation in the development of PGD.</p>}},
  author       = {{Niroomand, Anna and Qvarnström, Sara and Stenlo, Martin and Malmsjö, Malin and Ingemansson, Richard and Hyllén, Snejana and Lindstedt, Sandra}},
  issn         = {{0001-5172}},
  keywords     = {{lung transplant recipients; postoperative mechanical ventilation; primary graft dysfunction; protective lung ventilation}},
  language     = {{eng}},
  number       = {{4}},
  pages        = {{483--496}},
  publisher    = {{Blackwell Munksgaard}},
  series       = {{Acta Anaesthesiologica Scandinavica}},
  title        = {{The role of mechanical ventilation in primary graft dysfunction in the postoperative lung transplant recipient : A single center study and literature review}},
  url          = {{http://dx.doi.org/10.1111/aas.14025}},
  doi          = {{10.1111/aas.14025}},
  volume       = {{66}},
  year         = {{2022}},
}