Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Jacksonville, Florida.
Department of Anesthesiology, University of Colorado Denver, Aurora, Colorado, USA.
Curr Opin Anaesthesiol. 2020 Feb;33(1):43-49. doi: 10.1097/ACO.0000000000000805.
Recent literature has described the emerging role of anesthesiologists as key members of the lung transplantation team and the impact of anesthetic management on outcomes. This review examines the impact of presenting cause of end-stage lung disease (ESLD) on anesthetic management.
The four primary causes of ESLD are suppurative, obstructive, or restrictive processes, and pulmonary hypertension. Our recent review of perioperative literature revealed new data regarding preoperative risk stratification, intraoperative management, and postoperative use of extracorporeal membrane oxygenation (ECMO) support. Major studies specifically about anesthetic management are lacking; however, the principles studied are readily applicable to the design of a perioperative care plan. The most compelling data have resulted in a revolutionary change in terms of intraoperative support and postoperative planning for pulmonary hypertension patients. Historically treated with cardiopulmonary bypass, significant data have been reported describing the successful use of ECMO both as an intraoperative support with superior outcomes, as well as postoperative support for improved stability during biventricular remodeling post graft implantation.
The application of these updated findings should assist anesthesiologists as they develop internal protocols and external guidelines to integrate within multidisciplinary teams caring for the lung transplant patient.
最近的文献描述了麻醉医师作为肺移植团队关键成员的新角色，以及麻醉管理对结果的影响。本文综述了终末期肺病（ESLD）的主要病因对麻醉管理的影响。
ESLD 的四个主要病因是化脓性、阻塞性或限制性疾病以及肺动脉高压。我们最近对围手术期文献的回顾揭示了有关术前风险分层、术中管理以及术后体外膜肺氧合（ECMO）支持使用的新数据。关于麻醉管理的主要研究仍然缺乏；然而，所研究的原则很容易适用于围手术期护理计划的设计。最有说服力的数据导致了肺动脉高压患者术中支持和术后计划方面的革命性变化。肺动脉高压患者过去常采用心肺旁路治疗，但有大量数据表明，ECMO 在术中支持方面具有优越的效果，并且在移植后双心室重塑期间提供术后支持以提高稳定性方面也取得了成功。
这些最新发现的应用将帮助麻醉医师制定内部方案和外部指南，以便整合到多学科团队中，为肺移植患者提供护理。
