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J Thorac Cardiovasc Surg 2003;126:2106
© 2003 The American Association for Thoracic Surgery

Letter to the editor

Reply to the editor

Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, MO 63110-1013, USA

We are grateful for the confirmation provided by the letter and the case report by Haddy and colleagues. Readers interested in this phenomenon are encouraged to read their article¹ for a clear and methodical description of an event that sounds identical to our "index case" in 1997. After several sporadic observations over 3 years, we attempted to capture the phenomenon in a prospective fashion and the result is our own brief report.²

Our only disagreement with their letter is with the University of Southern California protocol for avoiding the stacking of breaths in transplant recipients with undersized grafts. In our experience, chest tubes placed to water-seal can still elicit the phenomenon when there is no air leak from the visceral pleural surface. This absence of air leaks may be uncommon after bilateral transplant, but we still begin with 1 tube on each side unconnected and thus open to atmospheric pressure. Also, the subsequent application of negative pressure to 1 of 2 chest tubes seems equivalent to applying it to both tubes: either the pleural pressure is negative or it is not. Two tubes on suction should only make a difference in pleural pressure if there are large air leaks and the removal of air from the pleural space is faster with 2 tubes on suction. If one tube is placed on suction and breath stacking does not happen immediately, our experience suggests that it will not occur.

Otherwise, we are reassured that our observations are validated by a simultaneous and independent report from a distinguished team of lung transplant experts.

	References

Top References

 

1. Haddy SM, Bremner RM, Moore-Jefferies EW, et al. Hyperinflation resulting in hemodynamic collapse following living donor lobar transplantation. Anesthesiology. 2002;97:1315–1317[Medline]
   
2. Kozower B, Meyers B, Ciccone A, Guthrie T, Patterson GA. Potential for detrimental hyperinflation after lung transplantation with application of negative pleural pressure to undersized lung grafts. J Thorac Cardiovasc Surg. 2003;125:430–432[Free Full Text]
   

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Benjamin Kozower Bryan Meyers Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kozower, B. Articles by Meyers, B. Search for Related Content PubMed Articles by Kozower, B. Articles by Meyers, B. Related Collections Lung - transplantation Related Article