1 University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Ann Am Thorac Soc. 2014 May;11(4):546-53. doi: 10.1513/AnnalsATS.201312-419OC.
Between 10% and 57% of lung transplant (LTx) recipients develop primary graft dysfunction (PGD) within 72 hours of LTx. PGD is clinically and histologically analogous to the acute respiratory distress syndrome. In patients at risk for or with acute respiratory distress syndrome, lung-protective ventilation strategies (low tidal volume and positive end-expiratory pressure) improve outcomes. There is, however, little information available on mechanical ventilation strategies after LTx.
Our aim in this international survey was to describe the current practices of mechanical ventilation immediately after LTx.
An electronic survey was sent to the medical and surgical directors of U.S. LTx programs (n = 111) and to members of the Pulmonary Council of the International Society for Heart and Lung Transplantation (n = 470).
A total of 149 individuals from 18 countries responded to the questionnaire. The most common modes of ventilation were pressure assist/control (37%) and volume assist/control (35%). Tidal volumes were most often determined by recipient characteristics. Donor characteristics were rarely considered (35%) and were infrequently known by the team managing the ventilator (42%). When presented with a choice of ideal tidal volumes, a majority of respondents selected 6 ml/kg recipient predicted body weight (58%), fewer selected 10 ml/kg (21%), and none selected 15 ml/kg. A majority preferred limiting the fraction of inspired oxygen rather than positive end-expiratory pressure (PEEP) (69% versus 31%, P = 0.006). The median minimum PEEP was 5 cm H2O, and the median maximum PEEP was 11.5 cm H2O. The presence of PGD increased the perceived importance of monitoring plateau pressure to adjust tidal volumes. The median plateau pressure limit perceived as a threshold triggering reduction in tidal volume was 30 cm H2O.
Most respondents reported using lung-protective approaches to mechanical ventilation after lung transplantation. Low tidal volumes based on recipient characteristics were frequently chosen. Donor characteristics often were not considered and frequently were not known by the team managing mechanical ventilation after LTx.
肺移植（LTx）后 10%至 57%的受者在 LTx 后 72 小时内发生原发性移植物功能障碍（PGD）。PGD 在临床上和组织学上类似于急性呼吸窘迫综合征。在有急性呼吸窘迫综合征风险或患有急性呼吸窘迫综合征的患者中，肺保护性通气策略（小潮气量和呼气末正压）可改善预后。然而，关于 LTx 后机械通气策略的信息很少。
我们在这项国际调查中的目的是描述 LTx 后立即进行机械通气的当前实践。
向美国 LTx 项目的医疗和外科主任（n=111）以及国际心肺移植学会肺脏委员会成员（n=470）发送了电子调查问卷。
来自 18 个国家的 149 人对问卷做出了回应。最常用的通气模式是压力辅助/控制（37%）和容量辅助/控制（35%）。潮气量通常根据受者特征确定。供者特征很少被考虑（35%），且管理呼吸机的团队很少了解（42%）。当面临理想潮气量选择时，大多数受访者选择 6ml/kg 受者预测体重（58%），选择 10ml/kg 的人数较少（21%），选择 15ml/kg 的人数为零。大多数人更喜欢限制吸入氧分数而不是呼气末正压（PEEP）（69%对 31%，P=0.006）。中位最低 PEEP 为 5cmH2O，中位最大 PEEP 为 11.5cmH2O。PGD 的存在增加了监测平台压以调整潮气量的重要性。认为触发潮气量减少的平台压限值为 30cmH2O 的中位数。
大多数受访者报告在肺移植后使用肺保护性机械通气方法。基于受者特征的小潮气量经常被选择。供者特征通常未被考虑，且管理 LTx 后机械通气的团队通常不了解供者特征。
