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J Thorac Cardiovasc Surg 2003;125:430-432
© 2003 The American Association for Thoracic Surgery

Brief Communications

Potential for detrimental hyperinflation after lung transplantation with application of negative pleural pressure to undersized lung grafts

From the Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Mo.

Received for publication April 18, 2002. Accepted for publication July 15, 2002. Address for reprints: Bryan Meyers, MD, Suite 3108, Queeny Tower, One Barnes-Jewish Hospital Plaza, St Louis, MO 63110-1013 (E-mail: meyersb@msnotes.wustl.edu).

The first 20% of the full text of this article appears below.

In our program, postoperative lung recipients are temporarily maintained on positive-pressure ventilation, with suction routinely applied to the thoracostomy tubes. We have occasionally seen negative pleural pressure applied to a large pleural space alter the respiratory mechanics of lung allografts and contribute to primary graft failure. We hypothesize that the combination of undersized lung grafts and negative pleural pressure may inhibit the lung's elastic recoil and lead to detrimental hyperinflation. If alveoli decompress incompletely during exhalation, functional residual capacity increases, and subsequent mechanical ventilations are delivered to partially distended lungs. After several stacked breaths, lungs hyperinflate and operate on a flatter portion of the volume-pressure curve. During volume-cycled ventilation, this manifests as increased airway pressure, with an increased potential for barotrauma. We prospectively studied this phenomenon after bilateral lung transplantation.

Methods

Consent was obtained from the patients, and the study was approved by the human studies committee. Twenty-four bilateral lung transplant recipients were studied between July 17, 2001, and April 9, 2002. Transplant indications included emphysema (n = 16), cystic fibrosis (n = 6), idiopathic pulmonary fibrosis (n = 1), and lymphangioleiomyomatosis (n = 1). Patients were evaluated within 6 hours of reperfusion while they were receiving mechanical ventilation at a tidal volume of 10 mL/kg (volume-cycled ventilation). Thoracostomy tubes were placed to . . . [Full Text of this Article]

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				S. Haddy and V. A. Starnes Lobar transplantation J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 2106 - 2106. [Full Text] [PDF]

				B. Kozower and B. Meyers Reply to the editor J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 2106 - 2106. [Full Text] [PDF]