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Professor Malin Malmsjö, MD, PhD. Photo.

Malin Malmsjö

Professor

Professor Malin Malmsjö, MD, PhD. Photo.

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

Author

  • Anna Niroomand
  • Sara Qvarnström
  • Martin Stenlo
  • Malin Malmsjö
  • Richard Ingemansson
  • Snejana Hyllén
  • Sandra Lindstedt

Summary, in English

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.

Department/s

  • Thoracic Surgery
  • Anesthesiology and Intensive Care
  • StemTherapy: National Initiative on Stem Cells for Regenerative Therapy
  • Ophthalmology, Lund
  • NPWT technology
  • Clinical and experimental lung transplantation
  • Ophthalmology Imaging Research Group
  • DCD transplantation of lungs
  • WCMM-Wallenberg Centre for Molecular Medicine

Publishing year

2022-04

Language

English

Pages

483-496

Publication/Series

Acta Anaesthesiologica Scandinavica

Volume

66

Issue

4

Document type

Journal article

Publisher

Wiley-Blackwell

Topic

  • Anesthesiology and Intensive Care

Keywords

  • lung transplant recipients
  • postoperative mechanical ventilation
  • primary graft dysfunction
  • protective lung ventilation

Status

Published

Research group

  • NPWT technology
  • Clinical and experimental lung transplantation
  • Ophthalmology Imaging Research Group
  • DCD transplantation of lungs

ISBN/ISSN/Other

  • ISSN: 0001-5172