Julien Fessler , Wenting Ma , Archer K. Martin , Brandi Bottiger , Arne Neyrinck , Sebastien Jacqmin , Morgan Le Guen , Nandor Marczin
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引用次数: 0
Abstract
Protective ventilation is a cornerstone of perioperative management during lung transplantation. However, its current clinical approach is mainly based on literature from intensive care and elective surgery with one-lung ventilation. This review summarizes the pathophysiology of each of the four main end-stage lung diseases and how mechanical power affects the energy exerted on the lungs during the different surgical steps, first on the host and then on the grafts. Each pathology presents specific parenchymal characteristics, and there is great heterogeneity in pulmonary compliance within and between patients. Recognizing these regional heterogeneities in compliance is fundamental to personalizing ventilator settings and avoiding increasing ventilator-induced lung injury.
Furthermore, we explored the concept of the multiple-hits model of lung allograft injury. It highlights the consequences over time (additive or synergic) of all the risk factors cumulated on allograft injury, from the donor before harvesting, to the transport, and finally after implantation. Additionally, we discussed the novel opportunity that ex-vivo lung perfusion offers in the assessment of graft quality using various parameters, as well as mechanical power to guide different modes and settings to optimize ventilation. This experimental model could be used to develop new specific ventilation strategies to optimize the mechanical energy exerted on the lungs without a chest wall. Finally, we advocate for early extubation to reduce ventilation-induced lung injury and promote early rehabilitation.
期刊介绍:
The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained.
The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.