Summary of perioperative hemodynamic management of 19 lung transplant recipients

Abstract

Objective: To summarize and discuss the experience of perioperative hemodynamic management of lung transplant recipients. Methods: A total of 19 lung transplant recipients from December 2016 to December 2020 were investigated in Renmin Hospital of Wuhan University, all of which were transferred to the intensive care unit for further monitoring and treatment, and their clinical data were retrospectively analyzed. Results: The 19 lung transplant recipients included 5 cases of chronic obstructive pulmonary disease (COPD), 5 cases of idiopathic pulmonary fibrosis (IPF), 4 cases of pneumoconiosis, 2 cases of bronchiectasis, 1 case of later lung fibrosis associated with COVID-19, 1 case of connective tissue disease-related pulmonary fibrosis, and 1 case of Kartagener syndrome. Twelve cases adopted double lung transplantation, while seven cases reveived unilateral lung transplantation (4 cases of left single lung transplantation and 3 cases of right single lung transplantation). There were 6 deaths during the perioperative period. One case died of multi-drug resistant bacteria infection, one case died of circulatory failure caused by active thoracic hemorrhage post-operation, the third case died of intraoperative cardiac arrest, and the other 3 cases were given up because of multiple organs failure. The remaining 13 cases were cured and discharged. Of the 19 recipients, 14 received vasopressors. The total and daily fluid output of the recipients in 3 postoperation days were greater than the input volume (P<0.05). Conclusion: Lung transplantation is an effective method for the treatment of end-stage lung disease. The hemodynamic management is a keypoint during perioperative period. It is import to maintain the blood volume as low as possible under the premise of systemic perfusion, limit the amount of fluid, choose albumin or plasma to increase the colloidal osmotic pressure, and strengthen the maintenance of right heart function. These abobe measures may improve the prognosis of lung transplant recipients. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.