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Contemporary Reviews in Critical Care Medicine |

ICU Care Before and After Lung Transplantation

Thomas Fuehner, MD; Christian Kuehn, MD; Tobias Welte, MD; Jens Gottlieb, MD
Author and Funding Information

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

aDepartment of Respiratory Medicine, Hannover Medical School, Hannover, Germany

bDepartment of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany

CORRESPONDENCE TO: Thomas Fuehner, MD, Hannover Medical School, Department of Respiratory Medicine OE6870, Carl-Neuberg-Str. 1, 30625 Hannover, Germany


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(2):442-450. doi:10.1016/j.chest.2016.02.656
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Lung transplantation (LTx) has become an accepted treatment for carefully selected patients with end-stage lung disease. Critical care issues have gained importance concerning bridging of candidates by mechanical respiratory support and are involved in the care after transplantation. The nature of respiratory support varies from oxygen supply and noninvasive ventilation, to mechanical respiratory support either by mechanical ventilation and/or extracorporeal life support. Recent innovations in extracorporeal life support technology have resulted in its more widespread use. Retrospective studies have demonstrated promising outcomes in candidates on mechanical respiratory support as a bridge to lung transplantation. The role of mechanical respiratory support has influenced the selection criteria for LTx, although bridging remains technically and ethically challenging. Critical care is integral to manage and prevent postoperative complications of LTx. Primary graft dysfunction and prolonged mechanical ventilation are major obstacles to hospital survival after LTx. Clear evidence is lacking on how to ventilate and optimally manage patients after LTx. Prolonged extracorporeal life support after LTx may improve outcome in selected patients with a primary graft dysfunction.

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