Rounding in the Intensive Care Unit After Lung Transplantation

Lung transplantation is an effective treatment option for end-stage lung disease patients that can improve quality of life and prolong survival. However, despite significant advances in surgical techniques, it remains an extremely demanding procedure and multiple intraoperative and postoperative pitfalls should be overcome to increase posttransplant survival. Mainstays of perioperative care consist of: successfully bridging patients to transplant, expanding the lung donor pool and preserving the graft, and preventing posttransplant complications that include primary graft dysfunction, cellular and antibody-mediated rejection, chronic lung allograft dysfunction, and infections as well as extrapulmonary complications. Primary graft dysfunction is the most serious complication following lung transplantation associated with early and late morbidity and mortality. Quick recognition and diagnosis allow early supportive treatment and protective ventilation. Early extubation, appropriate and effective analgesia, prevention of hemodynamic complications, and gastrointestinal disturbances are crucial to favor recovery of graft and rapid rehabilitation with significant improvement of morbidity and mortality rate. Prompt extracorporeal support should be considered if supportive strategies are not sufficient.