Lung Transplant for the Critical Care Nurse - 26/07/19

Doi : 10.1016/j.cnc.2019.05.001

Kevin C. Carney, MSN, CRNP ^a,^⁎ , Tanya Bronzell-Wynder, DNP, CRNP ^a, Karen Gronek, MSN, CRNP ^b
^a Lung Center Service Line, Temple University Hospital, 6th floor Rock Pavilion, 3401 North Broad Street, Philadelphia, PA 19140, USA
^b Department of Cardiovascular Surgery, Temple University Hospital, 2nd floor Rock Pavilion, 3401 North Broad Street, Philadelphia, PA 19140, USA

^∗Corresponding author.

Résumé

Lung transplantation is an established treatment of select patients with end-stage pulmonary disease. Lung transplantation should be considered for patients with end-stage pulmonary disease who have an expected 2-year survival of less than 50% without lung transplant and an expected 5-year survival of greater than 80% after transplant. This article reviews routine postsurgical intensive care unit management, along with management of complications such as acute kidney injury, atrial arrhythmias, deep vein thrombosis, primary graft dysfunction, hyperammonemia syndrome, and thrombocytopenia. Finally, management of long-term issues, including diabetes mellitus, hypertension, and bronchial stenosis, is discussed.

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Keywords : Lung transplant, Respiratory failure, Immunosuppression, ECMO, Cardiothoracic surgery

Plan

Key points

Introduction

Survival and quality of life

Diagnoses and timing of referral

Older patients

Lung transplant evaluation

Listing for lung transplant and waitlist management

Donor/recipient matching

Supportive therapies

Surgical approach

Induction therapy

Immunosuppression management (maintenance therapy)

Prophylaxis against opportunistic infection

Immediate posttransplant management

Ventilator Management and Extubation

Hemodynamic assessment and management

Primary graft dysfunction

Perioperative antibiotics

Postoperative complications

Acute Kidney Injury

Electrolyte Imbalances

Atrial Arrhythmias/Atrial Fibrillation

Hyperammonemia Syndrome

Deep Vein Thrombosis

Thrombocytopenia

Neurologic complications

Malnutrition

Gastro esophageal reflux disease

Gastroparesis

Posttransplant constipation

Ward management

Discharge planning and the interdisciplinary team

Comorbidities after lung transplant

	Disclosure Statement: The authors have nothing to disclose.
	The authors have no financial conflicts of interest and have not received funding for this article.