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Intra-operative protective mechanical ventilation in lung transplantation: a randomised, controlled trial.
Verbeek, G L; Myles, P S; Westall, G P; Lin, E; Hastings, S L; Marasco, S F; Jaffar, J; Meehan, A C.
Afiliação
  • Verbeek GL; Department of Anaesthesia and Peri-operative Medicine, The Alfred Hospital, Melbourne, Australia.
  • Myles PS; Department of Anaesthesia and Peri-operative Medicine, The Alfred Hospital, Melbourne, Australia.
  • Westall GP; Cardiothoracic Unit, The Alfred Hospital, Melbourne, Australia.
  • Lin E; Cardiothoracic Unit, The Alfred Hospital, Melbourne, Australia.
  • Hastings SL; Cardiothoracic Unit, The Alfred Hospital, Melbourne, Australia.
  • Marasco SF; Cardiothoracic Unit, The Alfred Hospital, Melbourne, Australia.
  • Jaffar J; Department of Immunology, Monash University, Melbourne, Australia.
  • Meehan AC; Department of Immunology, Monash University, Melbourne, Australia.
Anaesthesia ; 72(8): 993-1004, 2017 Aug.
Article em En | MEDLINE | ID: mdl-28695586
Primary graft dysfunction occurs in up to 25% of patients after lung transplantation. Contributing factors include ventilator-induced lung injury, cardiopulmonary bypass, ischaemia-reperfusion injury and excessive fluid administration. We evaluated the feasibility, safety and efficacy of an open-lung protective ventilation strategy aimed at reducing ventilator-induced lung injury. We enrolled adult patients scheduled to undergo bilateral sequential lung transplantation, and randomly assigned them to either a control group (volume-controlled ventilation with 5 cmH2 O, positive end-expiratory pressure, low tidal volumes (two-lung ventilation 6 ml.kg-1 , one-lung ventilation 4 ml.kg-1 )) or an alveolar recruitment group (regular step-wise positive end-expiratory pressure-based alveolar recruitment manoeuvres, pressure-controlled ventilation set at 16 cmH2 O with 10 cmH2 O positive end-expiratory pressure). Ventilation strategies were commenced from reperfusion of the first lung allograft and continued for the duration of surgery. Regular PaO2 /FI O2 ratios were calculated and venous blood samples collected for inflammatory marker evaluation during the procedure and for the first 24 h of intensive care stay. The primary end-point was the PaO2 /FI O2 ratio at 24 h after first lung reperfusion. Thirty adult patients were studied. The primary outcome was not different between groups (mean (SD) PaO2 /FI O2 ratio control group 340 (111) vs. alveolar recruitment group 404 (153); adjusted p = 0.26). Patients in the control group had poorer mean (SD) PaO2 /FI O2 ratios at the end of the surgical procedure and a longer median (IQR [range]) time to tracheal extubation compared with the alveolar recruitment group (308 (144) vs. 402 (154) (p = 0.03) and 18 (10-27 [5-468]) h vs. 15 (11-36 [5-115]) h (p = 0.01), respectively). An open-lung protective ventilation strategy during surgery for lung transplantation is feasible, safe and achieves favourable ventilation parameters.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Respiração Artificial / Transplante de Pulmão / Lesão Pulmonar Induzida por Ventilação Mecânica Tipo de estudo: Clinical_trials Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2017 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Respiração Artificial / Transplante de Pulmão / Lesão Pulmonar Induzida por Ventilação Mecânica Tipo de estudo: Clinical_trials Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2017 Tipo de documento: Article