Abstract
Primary graft dysfunction occurs in up to 25% of patients after lung transplantation. Contributing factors include ventilator-induced lung injury, cardiopulmonary bypass, ischaemia-reperfusion injury and excessive fluid administration. We evaluated the feasibility, safety and efficacy of an open-lung protective ventilation strategy aimed at reducing ventilator-induced lung injury. We enrolled adult patients scheduled to undergo bilateral sequential lung transplantation, and randomly assigned them to either a control group (volume-controlled ventilation with 5 cmH2O, positive end-expiratory pressure, low tidal volumes (two-lung ventilation 6 ml.kg−1, one-lung ventilation 4 ml.kg−1)) or an alveolar recruitment group (regular step-wise positive end-expiratory pressure-based alveolar recruitment manoeuvres, pressure-controlled ventilation set at 16 cmH2O with 10 cmH2O positive end-expiratory pressure). Ventilation strategies were commenced from reperfusion of the first lung allograft and continued for the duration of surgery. Regular PaO2/FIO2 ratios were calculated and venous blood samples collected for inflammatory marker evaluation during the procedure and for the first 24 h of intensive care stay. The primary end-point was the PaO2/FIO2 ratio at 24 h after first lung reperfusion. Thirty adult patients were studied. The primary outcome was not different between groups (mean (SD) PaO2/FIO2 ratio control group 340 (111) vs. alveolar recruitment group 404 (153); adjusted p = 0.26). Patients in the control group had poorer mean (SD) PaO2/FIO2 ratios at the end of the surgical procedure and a longer median (IQR [range]) time to tracheal extubation compared with the alveolar recruitment group (308 (144) vs. 402 (154) (p = 0.03) and 18 (10–27 [5–468]) h vs. 15 (11–36 [5–115]) h (p = 0.01), respectively). An open-lung protective ventilation strategy during surgery for lung transplantation is feasible, safe and achieves favourable ventilation parameters.
| Original language | English |
|---|---|
| Pages (from-to) | 993-1004 |
| Number of pages | 12 |
| Journal | Anaesthesia |
| Volume | 72 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - 1 Aug 2017 |
Keywords
- lung protection ventilation
- lungs: management
- organ donor
- ventilator: low tidal volume
Cite this
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Intra-operative protective mechanical ventilation in lung transplantation : a randomised, controlled trial. / Verbeek, G L; Myles, P S; Westall, G. P.; Lin, E; Hastings, S. L.; Marasco, S. F.; Jaffar, J.; Meehan, A C.
In: Anaesthesia, Vol. 72, No. 8, 01.08.2017, p. 993-1004.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Intra-operative protective mechanical ventilation in lung transplantation
T2 - a randomised, controlled trial
AU - Verbeek, G L
AU - Myles, P S
AU - Westall, G. P.
AU - Lin, E
AU - Hastings, S. L.
AU - Marasco, S. F.
AU - Jaffar, J.
AU - Meehan, A C
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Primary graft dysfunction occurs in up to 25% of patients after lung transplantation. Contributing factors include ventilator-induced lung injury, cardiopulmonary bypass, ischaemia-reperfusion injury and excessive fluid administration. We evaluated the feasibility, safety and efficacy of an open-lung protective ventilation strategy aimed at reducing ventilator-induced lung injury. We enrolled adult patients scheduled to undergo bilateral sequential lung transplantation, and randomly assigned them to either a control group (volume-controlled ventilation with 5 cmH2O, positive end-expiratory pressure, low tidal volumes (two-lung ventilation 6 ml.kg−1, one-lung ventilation 4 ml.kg−1)) or an alveolar recruitment group (regular step-wise positive end-expiratory pressure-based alveolar recruitment manoeuvres, pressure-controlled ventilation set at 16 cmH2O with 10 cmH2O positive end-expiratory pressure). Ventilation strategies were commenced from reperfusion of the first lung allograft and continued for the duration of surgery. Regular PaO2/FIO2 ratios were calculated and venous blood samples collected for inflammatory marker evaluation during the procedure and for the first 24 h of intensive care stay. The primary end-point was the PaO2/FIO2 ratio at 24 h after first lung reperfusion. Thirty adult patients were studied. The primary outcome was not different between groups (mean (SD) PaO2/FIO2 ratio control group 340 (111) vs. alveolar recruitment group 404 (153); adjusted p = 0.26). Patients in the control group had poorer mean (SD) PaO2/FIO2 ratios at the end of the surgical procedure and a longer median (IQR [range]) time to tracheal extubation compared with the alveolar recruitment group (308 (144) vs. 402 (154) (p = 0.03) and 18 (10–27 [5–468]) h vs. 15 (11–36 [5–115]) h (p = 0.01), respectively). An open-lung protective ventilation strategy during surgery for lung transplantation is feasible, safe and achieves favourable ventilation parameters.
AB - Primary graft dysfunction occurs in up to 25% of patients after lung transplantation. Contributing factors include ventilator-induced lung injury, cardiopulmonary bypass, ischaemia-reperfusion injury and excessive fluid administration. We evaluated the feasibility, safety and efficacy of an open-lung protective ventilation strategy aimed at reducing ventilator-induced lung injury. We enrolled adult patients scheduled to undergo bilateral sequential lung transplantation, and randomly assigned them to either a control group (volume-controlled ventilation with 5 cmH2O, positive end-expiratory pressure, low tidal volumes (two-lung ventilation 6 ml.kg−1, one-lung ventilation 4 ml.kg−1)) or an alveolar recruitment group (regular step-wise positive end-expiratory pressure-based alveolar recruitment manoeuvres, pressure-controlled ventilation set at 16 cmH2O with 10 cmH2O positive end-expiratory pressure). Ventilation strategies were commenced from reperfusion of the first lung allograft and continued for the duration of surgery. Regular PaO2/FIO2 ratios were calculated and venous blood samples collected for inflammatory marker evaluation during the procedure and for the first 24 h of intensive care stay. The primary end-point was the PaO2/FIO2 ratio at 24 h after first lung reperfusion. Thirty adult patients were studied. The primary outcome was not different between groups (mean (SD) PaO2/FIO2 ratio control group 340 (111) vs. alveolar recruitment group 404 (153); adjusted p = 0.26). Patients in the control group had poorer mean (SD) PaO2/FIO2 ratios at the end of the surgical procedure and a longer median (IQR [range]) time to tracheal extubation compared with the alveolar recruitment group (308 (144) vs. 402 (154) (p = 0.03) and 18 (10–27 [5–468]) h vs. 15 (11–36 [5–115]) h (p = 0.01), respectively). An open-lung protective ventilation strategy during surgery for lung transplantation is feasible, safe and achieves favourable ventilation parameters.
KW - lung protection ventilation
KW - lungs: management
KW - organ donor
KW - ventilator: low tidal volume
UR - http://www.scopus.com/inward/record.url?scp=85022231308&partnerID=8YFLogxK
U2 - 10.1111/anae.13964
DO - 10.1111/anae.13964
M3 - Article
VL - 72
SP - 993
EP - 1004
JO - Anaesthesia
JF - Anaesthesia
SN - 0003-2409
IS - 8
ER -