Fast-Tracking in Lung Transplantation: OR-Extubation

Purpose Fast-tracking in cardiac-thoracic surgery is highly challenging. It requires multimodal and transdisciplinary collaboration. Early postoperative extubation in the operating room (OR) is an aspect of this strategy1. The objective of the present study was to report our whole experience of immediate end-surgery extubation after lung transplantation. Methods The Ethical Board of the French Society for Anesthesia and Intensive Care approved this analysis of the prospectively Lung Transplant database. All consecutive patients undergoing double-lung transplantation from January 2012 to December 2018 were analyzed, except repeated transplantation during the study period, and transplantation under cardiopulmonary bypass. The cardio-respiratory weaning protocol has been previously published2 (Figure). The aims of the study were: to identify factors predicting immediate extubation, and to compare outcome among patients. Results Among the 410 patients included, 142 (34.6%) were extubated in the OR. Predictive factors for OR extubation are reported in Table 1. Postoperative outcomes are summarized in Table 2. Conclusion Immediate extubation via a fast-tracking protocol is feasible after lung transplantation. It forecasts a positive outcome. It requires transdisciplinary collaboration.