Dong Yan, Xu Zhongping, Tian Jing, Wang Dapeng, Chen Jingyu, Xu Hongyang
Department of Critical Care Medicine, Wuxi People's Hospital, Wuxi Medical Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Nanjing Medical University, Wuxi, China.
Lung Transplant Center, Department of Thoracic Surgery, Wuxi People's Hospital, Wuxi Medical Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Nanjing Medical University, Wuxi, China.
BMC Anesthesiol. 2025 Apr 23;25(1):194. doi: 10.1186/s12871-025-03033-x.
Primary graft dysfunction Grade 3 (PGD 3) following lung transplantation significantly increases the incidence of acute and chronic complications. These effects complicate clinical perioperative management and significantly increase mortality. Here, we report a case of PGD 3 and refractory hypoxemia after bilateral lung transplantation at our center. Despite ongoing extracorporeal membrane oxygenation (ECMO) support, the patient's partial pressure of oxygen (PaO₂) remained suboptimal at 71.7 mmHg on postoperative day 4, precluding safe discontinuation of ECMO support. Consequently, EIT-guided interventions-including prone positioning optimization and inhaled nitric oxide (iNO) therapy-were implemented to improve oxygenation. After undergoing a rigorous treatment process, the patient was successfully weaned off ECMO on the 10th day and transitioned out of the intensive care unit (ICU) on the 24th postoperative day. The combination of prone positioning and iNO therapy, tailored through EIT-guided interventions, provided an innovative approach to post-lung transplant management and had the potential to save patients' lives.
肺移植术后3级原发性移植物功能障碍（PGD 3）显著增加急性和慢性并发症的发生率。这些影响使临床围手术期管理复杂化，并显著增加死亡率。在此，我们报告了我们中心1例双侧肺移植术后发生PGD 3和难治性低氧血症的病例。尽管持续进行体外膜肺氧合（ECMO）支持，但患者术后第4天的氧分压（PaO₂）仍不理想，为71.7 mmHg，无法安全停用ECMO支持。因此，实施了电阻抗断层成像（EIT）引导的干预措施，包括优化俯卧位和吸入一氧化氮（iNO）治疗，以改善氧合。经过严格的治疗过程，患者在第10天成功撤机，并于术后第24天转出重症监护病房（ICU）。通过EIT引导的干预措施进行调整的俯卧位和iNO治疗相结合，为肺移植术后管理提供了一种创新方法，有可能挽救患者生命。
