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J Thorac Cardiovasc Surg 2007;133:1071-1077
© 2007 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Predictors of independent lung ventilation: An analysis of 170 single-lung transplantations

^a Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia.
^b Department of Allergy, Immunology, and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.

Received for publication June 29, 2006; revisions received September 28, 2006; accepted for publication October 9, 2006.

^_* Address for reprints: David Pilcher, MD, Intensive Care Unit, The Alfred Hospital, Commercial Rd, Prahran 3181, Victoria, Australia. (Email: d.pilcher{at}alfred.org.au).

Objective: Single-lung transplantation for chronic obstructive pulmonary disease can cause unique postoperative problems that might require independent lung ventilation. We evaluated preoperative and immediate postoperative factors to predict the need for independent lung ventilation.

Methods: We retrospectively studied 170 patients who received a single-lung transplant over a 15-year period, 20 (12%) of whom required independent lung ventilation.

Results: Patients requiring independent lung ventilation were similar in age, sex, ischemic time, and donor characteristics to those who required conventional ventilation. Patients receiving independent lung ventilation had a greater degree of preoperative airflow limitation, more hyperinflation, lower postoperative PaO ₂/fraction of inspired oxygen ratios, more radiologic mediastinal shift, and more transplant lung infiltrate on the postoperative chest radiograph. Multivariate logistic regression analysis showed that independent lung ventilation was associated with increasing levels of recipient hyperinflation (percentage total lung capacity compared with predicted value; odds ratio, 1.04; 95% confidence interval, 1.01-1.07; P = .032) and reduced early postoperative PaO ₂/fraction of inspired oxygen ratio (odds ratio, 0.97; 95% confidence interval, 0.95-0.99; P = .005). Length of ventilation and intensive care unit stay and mortality were higher in the independent lung ventilation group. Among patients who survived to hospital discharge, there were no differences in long-term mortality between the 2 groups.

Conclusions: The need for independent lung ventilation in patients undergoing single-lung transplantation for obstructive lung disease is predicted by the combination of increased hyperinflation measured on recipients’ preoperative lung function tests and a low PaO ₂/fraction of inspired oxygen ratio, indicating graft dysfunction in the immediate postoperative period.

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				J. G.T. Augoustides Independent lung ventilation in adult single-lung transplantation: Is it time for fast-track anesthesia and early tracheal extubation? J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 825 - 825. [Full Text] [PDF]

				D. V. Pilcher, G. M. Auzinger, B. Mitra, D. V. Tuxen, R. F. Salamonsen, A. R. Davies, T. J. Williams, and G. I. Snell Reply to the Editor J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 825 - 826. [Full Text] [PDF]