POST- (H)LTX MANAGEMENT
Physiologic changes observed immediately after lung implantation with
normalization of PVR should be anticipated; there is an increase in
cardiac output and increase in left ventricular (LV) filling with acute
LV dilation. This acute change in myocardial length-tension relationship
can lead to LV failure. LV failure predisposes to elevation in
post-capillary pulmonary vascular pressures which can lead to pulmonary
edema and classic features of primary graft dysfunction. At the same
time, RV dilation is immediately reduced resulting in a different
length-tension alteration which may also compromise RV function, which
is commonly compromised going into surgery. Treatment includes
protective ventilator strategies, appropriate pressor support and fluid
management to maintain normovolemia; beta-blockers may be considered to
limit cardiac output. Post-operative ECMO support should be considered
within 48 hours for patients with unrelenting low cardiac output and/or
low lung compliance requiring PIP > 35 cmH2O and FiO2
>0.6 15. Induction, immunosuppression,
prophylaxis and surveillance are not different from patients without PH8.