Jeon Kyeongman
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Chest Surg. 2022 Aug 5;55(4):325-331. doi: 10.5090/jcs.22.067.
Postoperative critical care management for lung transplant recipients in the intensive care unit (ICU) has expanded in recent years due to its complexity and impact on clinical outcomes. The practical aspects of post-transplant critical care management, especially regarding ventilation and hemodynamic management during the early postoperative period in the ICU, are discussed in this brief review. Monitoring in the ICU provides information on the patient's clinical status, diagnostic assessment of complications, and future management plans since lung transplantation involves unique pathophysiological conditions and risk factors for complications. After lung transplantation, the grafts should be appropriately ventilated with lung protective strategies to prevent ventilator-induced lung injury, as well as to promote graft function and maintain adequate gas exchange. Hypotension and varying degrees of pulmonary edema are common in the immediate postoperative lung transplantation setting. Ventricular dysfunction in lung transplant recipients should also be considered. Therefore, adequate volume and hemodynamic management with vasoactive agents based on their physiological effects and patient response are critical in the early postoperative lung transplantation period. Integrated management provided by a professional multidisciplinary team is essential for the critical care management of lung transplant recipients in the ICU.
近年来，由于肺移植受者术后在重症监护病房（ICU）的重症监护管理较为复杂且对临床结局有影响，其管理范围有所扩大。本简要综述讨论了移植后重症监护管理的实际方面，尤其是ICU术后早期的通气和血流动力学管理。ICU中的监测可提供有关患者临床状况的信息、并发症的诊断评估以及未来的管理计划，因为肺移植涉及独特的病理生理状况和并发症风险因素。肺移植后，应采用肺保护策略对移植物进行适当通气，以预防呼吸机诱发的肺损伤，促进移植物功能并维持充足的气体交换。低血压和不同程度的肺水肿在肺移植术后即刻很常见。还应考虑肺移植受者的心室功能障碍。因此，在肺移植术后早期，根据血管活性药物的生理作用和患者反应进行适当的容量和血流动力学管理至关重要。由专业多学科团队提供的综合管理对于ICU中肺移植受者的重症监护管理至关重要。
