The number of lung transplantations is progressively increasing worldwide, providing new challenges to interprofessional teams and the intensive care units. The outcome of lung transplantation recipients is critically affected by a complex interplay of particular pathophysiologic conditions and risk factors, knowledge of which is fundamental to appropriately manage these patients during the early postoperative course. As high-grade evidence-based guidelines are not available, the authors aimed to provide an updated review of the postoperative management of lung transplantation recipients in the intensive care unit, which addresses six main areas: (1) management of mechanical ventilation, (2) fluid and hemodynamic management, (3) immunosuppressive therapies, (4) prevention and management of neurologic complications, (5) antimicrobial therapy, and (6) management of nutritional support and abdominal complications. The integrated care provided by a dedicated multidisciplinary team is key to optimize the complex postoperative management of lung transplantation recipients in the intensive care unit.
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March 2022
Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit
Matteo Di Nardo, M.D.;
Matteo Di Nardo, M.D.
Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, Scientific Institute for Research, Hospitalization and Healthcare, Rome, Italy; the Toronto Lung Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Jussi Tikkanen, M.D.;
Jussi Tikkanen, M.D.
the Toronto Lung Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Shahid Husain, M.D.;
Shahid Husain, M.D.
the Toronto Lung Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Lianne G. Singer, M.D.;
Lianne G. Singer, M.D.
the Toronto Lung Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Marcelo Cypel, M.D.;
Marcelo Cypel, M.D.
the Toronto Lung Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Niall D. Ferguson, M.D.;
Niall D. Ferguson, M.D.
Interdepartmental Division of Critical Care Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Shaf Keshavjee, M.D.;
Shaf Keshavjee, M.D.
the Toronto Lung Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Lorenzo Del Sorbo, M.D.
Lorenzo Del Sorbo, M.D.
the Toronto Lung Transplant Program, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
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This article is featured in “This Month in Anesthesiology,” page A1.
Submitted for publication May 23, 2021. Accepted for publication September 28, 2021. Published online first on December 15, 2021.
Address correspondence to Dr. Del Sorbo: Toronto General Hospital, 585 University Avenue, PMB 11-122, Toronto, Ontario, Canada M5G 2N2. lorenzo.delsorbo@uhn.ca. Anesthesiology’s articles are made freely accessible to all readers on www.anesthesiology.org, for personal use only, 6 months from the cover date of the issue.
Anesthesiology March 2022, Vol. 136, 482–499.
Citation
Matteo Di Nardo, Jussi Tikkanen, Shahid Husain, Lianne G. Singer, Marcelo Cypel, Niall D. Ferguson, Shaf Keshavjee, Lorenzo Del Sorbo; Postoperative Management of Lung Transplant Recipients in the Intensive Care Unit. Anesthesiology 2022; 136:482–499 doi: https://doi.org/10.1097/ALN.0000000000004054
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