Intraoperative Anesthetic Management of Lung Transplantation: Center-Specific Practices and Geographic and Centers Size Differences.

OBJECTIVE: Although increasing evidence in lung transplantation (LTx) suggests that intraoperative management could influence outcomes, there are no guidelines available regarding intraoperative management of LTx. The overall goal of the study was to assess geographic and center volume-specific clinical practices in perioperative management. DESIGN: Prospective data analysis. SETTING: Online survey from a single-center university hospital. PARTICIPANTS: European and non-European LTx centers. INTERVENTIONS: An online survey was sent to 176 centers currently performing LTx procedures. It covered organizational data, general anesthesia considerations, fluid therapy and coagulation, antioxidant and anti-inflammatory therapies, and ventilation strategies. MEASUREMENTS AND MAIN RESULTS: The response rates were 57.5% (n = 42) from European and 32% (n = 33) from non-European countries. Significant differences between European and non-European countries were use of volatile hypnotics (p = 0.016), use of sufentanil (p < 0.001), inotropic agents (p = 0.001) and colloid infusion (p < 0.001), use of calibrated pulse contour analysis (p = 0.004), use of intraoperative traditional laboratory-based coagulation tests (p = 0.001) and platelet function analysis (p = 0.005), and use of higher peak inspiratory pressure (p = 0.009). Center volume-specific differences were use of fentanyl (p = 0.03) and the use of higher peak inspiratory pressure (p = 0.005) for ventilation. Induction of anesthesia and use of advanced hemodynamic monitoring, therapy for pulmonary hypertension, antioxidant and anti-inflammatory therapies, and ventilation strategies were not different among the centers. CONCLUSIONS: This survey demonstrated for the first time statistically significant differences among European and non-European centers and among low- versus high-volume centers regarding intraoperative management during LTx. These observations will be of some guidance for the LTx community and may trigger more extensive studies.

Residence-time distributions for chaotic flows in pipes.

In this paper we derive two rigorous properties of residence-time distributions for flows in pipes and mixers motivated by computational results of Khakhar et al. [Chem. Eng. Sci. 42, 2909 (1987)], using some concepts from ergodic theory. First, a curious similarity between the isoresidence-time plots and Poincare maps of the flow observed in Khakhar et al. is resolved. It is shown that in long pipes and mixers, Poincare maps can serve as a useful guide in the analysis of isoresidence-time plots, but the two are not equivalent. In particular, for long devices isoresidence-time sets are composed of orbits of the Poincare map, but each isoresidence-time set can be comprised of many orbits. Second, we explain the origin of multimodal residence-time distributions for nondiffusive motion of particles in pipes and mixers. It is shown that chaotic regions in the Poincare map contribute peaks to the appropriately defined and rescaled axial distribution functions. (c) 1999 American Institute of Physics.