Post Lung Transplant Patient
Considerations
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Allograft physiology:
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Heterogeneous compliance, impaired cough, disrupted lymphatics
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Need for differential lung ventilation if single lung transplant
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Extrapulmonary features of underlying disease requiring transplant (e.g., sarcoidosis, cystic fibrosis):
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Pulmonary hypertension, RV failure
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Complications:
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Allograft rejection
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Vascular & bronchial anastamotic complications
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Immunosuppression:
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Strict aseptic techniques, watch for infection
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Side effects: hematologic, renal, hepatic
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Goals/Conflicts
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Assess allograft function, anastamotic integrity, end-organ function
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Employ regional/neuraxial anesthesia if feasible
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If endotracheal intubation & PPV are required:
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Consider differential lung ventilation
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Lung protective ventilation to allograft & CPAP with 100% oxygen to native lung
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Restrictive fluid strategy
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Strict aseptic technique, avoidance of manipulation of airways, prophylactic antibiotics