Very early extubation and non invasive ventilation after lung transplantation

In recent years non invasive mechanical ventilation (NIV), delivered through facial or nose mask, has been successfully used as an effective treatment for acute respiratory failure and as a technique for weaning [1,2,3]. The aim of this study was to evaluate the use of NIV after very early extubation in lung transplanted patients.

Methods

Twelve patients (two single and 10 bilateral sequential lung transplantation), affected by cystic fibrosis (10) and emphysema (two) were early tracheal extubated, in the operating room. After tracheal extubation, five patients with PaO₂/FiO₂ < 180 mmHg and/or PaCO₂ = 70 mmHg and/or respiratory rate >30, were assisted with delivery of artificial, non invasive ventilation (NIV). NIV was intermittently applied for a period of 30-40 min, through a full face mask. Pressure support ventilation and ventilatory settings were adjusted based on continuous pulse-oximetry and on measurement of arterial blood gases analysis.

Results

Hemodynamics and oxygenations collected during mechanical ventilation at the end of surgery (FINAL), in spontaneous breathing 30 min after extubation (SB), 30 min after NIV application (NIV) and in spontaneous breathing 120 min after extubation (POST-NIV) are described in the Table.

Table

Discussion

During NIV we observed an improvement in pulmonary gas exchange with a decreasing in respiratory rate and an increasing in tidal volume. No patients were reintubated in ICU.

Conclusion

NIV permitted very early extubation after lung transplantation avoiding tracheal reintubation.