Lung Transplantation: Post-Operative ICU Management

Lung Transplantation: Post-Operative ICU Management

Aaron M. Cheng (University of Washington, USA), Michael S. Mulligan (University of Washington, USA) and Kei Togashi (University of Washington, USA)
Copyright: © 2015 |Pages: 20
DOI: 10.4018/978-1-4666-8603-8.ch027
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Abstract

Lung transplantation is a widely accepted surgical procedure for treatment of select patients suffering from end-stage lung disease. Recipients, however, require meticulous post-transplant care to preserve allograft lung function and to ensure optimal patient quality of life. In the post-operative period, these patients are predisposed to specific complications and pose unique considerations that clinicians caring for these patients in the intensive care setting should be familiar with managing. This chapter focuses on the early post-operative critical care management of the lung transplant recipient with specific emphasis on hemodynamic resuscitation; early lung graft dysfunction; and considerations regarding immunosuppression and infection. Non-pulmonary issues that affect the clinical care of these patients in the ICU setting are also discussed.
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Operative Procedure

The lung transplant procedure can be performed through standard thoracic incisions. The contemporary double lung transplant procedure is performed through a bilateral transverse thoracosternotomy (clamshell incision), which provides the surgeon excellent exposure and access to the pulmonary hilum and both pleural spaces; bilateral anterior thoracotomies without dividing the sternum, or median sternotomy—the original double lung technique, have also been described and are currently applied. Single lung transplantation is usually performed through a posterolateral or anterolateral thoracotomy.

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