*3.1.4 Postimplantation to lung allograft reperfusion/reexpansion*

Specific problems: systemic vasodilatation and hypotension, reperfusion pulmonary edema (increased vascular permeability and loss of lymphatic drainage), and hyperacute rejection.

Management strategies:


**101**

*Perioperative Care for Lung Transplant Recipients: A Multidisciplinary Approach*

vii.Five minutes after reperfusion, an ABG should be checked.

viii.After reperfusion, the TEE should be used to assess for LV and RV function, the presence of air in the left heart, and evidence of stenosis at the pulmo-

ix.A thermodilution cardiac output should be measured and recorded follow-

x.A cardiac index of 2.2–2.5 is ideal—higher rates of pulmonary blood flow may increase the risk of significant pulmonary edema. Specific hemody-

xi.Because of the adverse effects on donor lung function, the requirement for blood products should be agreed upon between the attending anesthesiolo-

xii.The double-lumen ETT tube will need to be changed to a single-lumen ETT at the end of the case to facilitate flexible bronchoscopy for anastomosis surveillance and tracheobronchial toilet. The FiO2 should be increased

i.Direct lung allograft compression leading to acute allograft dysfunction manifested by decreased compliance, derecruitment, and ventilationperfusion mismatch. Etiologies include excessive donor-recipient size mismatching, noncompliant "frozen" pleural cavity associated with pulmonary fibrosis, severe pleural thickening and/or calcification, asymmetric chest

ii.Direct cardiac compression resulting in a cardiac tamponade physiology.

• Ventilator adjustments to prevent barotrauma, i.e., transient reductions in TV

• Leaving the intercostal space open with closure of only the muscular, subcutaneous tissue and skin layers or lung volume reduction followed by attempted

This can occur during (i) ventilator disconnection prior to patient bed to bed transfer, (ii) switching to a single-lumen endotracheal tube to facilitate postprocedure bronchoscopy, (iii) airway dislodgement, and (iv) manual ventilation while

namic optimization strategies are detailed in Section 3.1.3 above.

*DOI: http://dx.doi.org/10.5772/intechopen.85277*

nary vein anastomoses.

gist and surgeon.

Management strategies include:

and/or PEEP

reclosure.

• Immediately reopening the chest

• Volume administration to optimize preload

*3.1.6 Disruption to positive pressure ventilation*

*3.1.5 Chest closure*

ing reperfusion and after chest closure.

transiently to 1.0 before this procedure.

Specific problems: restrictive chest cavity dynamics caused by:

cavities, severe kyphoscoliosis, and diaphragmatic elevation.

*Perioperative Care for Lung Transplant Recipients: A Multidisciplinary Approach DOI: http://dx.doi.org/10.5772/intechopen.85277*

