| 摘要 |
Recently, the necessity for critical care before and after lung
transplantation (LT) has steadily increased. Mechanical ventilation (MV), particularly posttransplant ventilation, is an important aspect of critical care for patients undergoing LT. Therefore, preventing and managing
ventilator‑associated complications, following LT is one of the important challenges ahead of intensivists for selecting MV strategies.[1] Primary graft dysfunction (PGD), a syndrome of acute lung injury, is one of the important
complications of LT, which occurs within the first 72 h following LT.[2] PGD is associated with substantial postoperative morbidity and mortality.[2] Estimates suggest that up to 57% of LT recipients experience PGD.[3] It is assumed that PGD and acute respiratory distress syndrome (ARDS) have similar underlying pathophysiology. Hence, it seems theoretically that any preventive or therapeutic approaches that diminish the rates of ARDS might improve the outcomes for recipients of LT.[3] The etiology of PGD following LT is
multifaceted, and it is the result of multiple pathways. It is supposed that ischemia‑reperfusion injury within 24 h of LT is an important factor that contributes to the PGD.[4] In this regards, several approaches have been used to early diagnose or prevent this complication by intensivists
including MV with low‑tidal‑volume ventilation (LTVV), inhibition of oxidative injury, anti‑inflammatory mediators, N‑acetyl cysteine, extracorporeal lung perfusion, activator of epithelial sodium channel‑mediated Na+ uptake, inhaled nitric oxide, and venoarterial extracorporeal membrane oxygenation.[5,6] The last three approaches are more commonly used to treat this condition. It should be noted that one preventative strategy will not be effective
for all recipients of LT, and a well‑personalized approach is required that involves the consideration of donor and recipient characteristics and clinical risk factors. |
