Hemodynamic and respiratory changes during lung transplant

OBJECTIVE: To study the hemodynamic and gasometric changes observed during lung transplantation, and discuss the differences between unilateral (ULT) and sequential bilateral lung transplantation (SBLT). PATIENTS AND METHODS: We enrolled 13 consecutive patients (8 ULT and 5 SBLT). Gasometric and hemodynamic readings, including right ventricular (RV) function measured as ejection fraction through a catheter, were recorded at the different phases of surgery. ANOVA and Neumann Keuls tests were used for statistical analysis. RESULTS: During ULT no significant changes in RV function were seen and gasometric alterations stayed within clinically tolerable limits. No significant hemodynamic or gasometric changes were observed during the first implantation during SBLT, although there was a significant increase in pulmonary artery pressure as cardiac index decreased, as well as significant depression of RV function and hypoxemia during reperfusion and ventilation of the first lung transplanted. Extracorporeal circulation was needed in one case. CONCLUSIONS: During SBLT, selective reperfusion and ventilation of the first transplanted lung is a moment of great hemodynamic and ventilatory instability. Exhaustive monitoring of RV function is essential for adequate management.