Przeszczep płuc: opieka medyczna nad dawcą

*Damian Czyżewski¹, Hanna Misiołek², Roman Przybylski³, Ewa Kucewicz-Czech³

Summary
The most common indications for lung transplantation are severe chronic obstructive pulmonary disease, pulmonary fibrosis and primary pulmonary hypertension. Simultaneous lung and heart transplantations are usually performed in patients with Eisenmenger syndrome. What is better – unilateral or bilateral lung transplantation – remains an open question. Because of the lack of suitable donors and better results, the unilateral procedure is preferred in many centers. On the other hand, bilateral transplant patients have better tolerance to stress, present less severe forms of the bronchiolitis obliterans syndrome, and have increased respiratory reserve, compared to patients after unilateral transplantation.
Patients with end-stage lung disease are at significant risk of hypoxia and dynamic hyperinflation during mechanical ventilation, particularly during one-lung ventilation. After intravenous induction, a double-lumen endotracheal tube is inserted, and anaesthesia is maintained with volatile agents or propofol, with epidural analgesia providing a useful adjunct. Nitrous oxide should be avoided. Particular attention to avoiding or reducing the impact of increases in pulmonary vascular resistance and right heart failure are important and may necessitate cardiopulmonary bypass. Minimizing the administration of intravenous fluids without compromising end organ perfusion may avoid or reduce postoperative respiratory insufficiency, and frusemide is routinely used. In approximately 10-20% of cases pulmonary hypertension is observed in the immediate postoperative period. It is managed by nitric oxide inhalation and/or prostacyclin infusion. Cardiopulmonary bypass is used mostly in cases of primary pulmonary hypertension.

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