Postoperative Management of Hyperinflated Native Lung in Single-Lung Transplant Recipients with Chronic Obstructive Pulm
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REVIEW
Postoperative Management of Hyperinflated Native Lung in Single-Lung Transplant Recipients with Chronic Obstructive Pulmonary Disease: A Review Article Islam M. Shehata . Amir Elhassan . Ivan Urits . Omar Viswanath . Leonardo Seoane . Courtney Shappley . Alan D. Kaye
Received: September 8, 2020 / Accepted: November 16, 2020 Ó The Author(s) 2020
ABSTRACT End-stage chronic obstructive pulmonary disease (COPD) is the most common indication for single- or double-lung transplantation. Acute
I. M. Shehata Department of Anesthesiology, Ain Shams Hospital, Cairo, Egypt A. Elhassan Cardiothoracic Anesthesia, Desert Regional Medical Center, Palm Springs, CA, USA I. Urits O. Viswanath A. D. Kaye (&) Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA e-mail: [email protected] I. Urits Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA O. Viswanath Valley Anesthesiology and Pain Consultants, Envision Physician Services, Phoenix, AZ, USA O. Viswanath Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA O. Viswanath University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA L. Seoane C. Shappley Pulmonology Critical Care Department, Ochsner Health, New Orleans, LA, USA
native lung hyperinflation (ANLH) is a unique postoperative complication of single-lung transplantation for COPD patients, with incidence varying in the medical literature from 15 to 30%. The diagnosis is made radiographically by contralateral mediastinal shift and ipsilateral diaphragmatic flattening. ANLH can deteriorate into hemodynamic instability, and respiratory impairment can result from compression of the allograft, which can precipitate atelectasis, hypoxemia, and hypercapnia, necessitating specific ventilatory intervention or volume reduction surgery. Currently, there is consensus for a therapeutic role of noninvasive positive pressure ventilation (NIPPV) in acute respiratory failure after lung transplantation as a welltolerated measure to avoid re-intubation. This manuscript presents a concise review on the diagnosis and treatment of ANLH following unilateral lung transplant, along with a management algorithm created by the authors.
Keywords: Chronic obstructive pulmonary disease (COPD); Hyperinflated lung; Lung reduction surgery; Lung transplant; Postoperative
Pulm Ther
Key Summary Points Acute native lung hyperinflation (ANLH) is a unique postoperative complication of single-lung transplantation for COPD patients. ANLH can deteriorate into hemodynamic instability, and respiratory impairment can result from compression of the allograft, which can precipitate atelectasis, hypoxemia, and hypercapnia necessitating specific ventilatory intervention or volume reduction surgery. If the patient develops respiratory failure diagnosed by radiology as ANLH, noninvasive positive pressure ventilation (NIPPV) or high-flow nasal cannula (HFNC) oxygen therapy should be applied
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