Critical Care before Lung Transplantation

Abstract

Lung transplantation is widely accepted as the only viable treatment option for patients with end-stage lung disease. However, the imbalance between the number of suitable donor lungs available and the number of possible candidates often results in intensive care unit (ICU) admission for the latter. In the ICU setting, critical care is essential to keep these patients alive and to successfully bridge to lung transplantation. Proper management in the ICU is also one of the key factors supporting long-term success following transplantation. Critical care includes the provision of respiratory support such as mechanical ventilation (MV) and extracorporeal life support (ECLS). Accordingly, a working knowledge of the common critical care issues related to these unique patients and the early recognition and management of problems that arise before and after transplantation in the ICU setting are crucial for long-term success. In this review, we discuss the management and selection of candidates for lung transplantation as well as existing respiratory support strategies that involve MV and ECLS in the ICU setting.

Keywords: critical care; donor selection; extracorporeal life support; lung transplantation; mechanical ventilation; preoperative care; transplant recipients.

Figure 1.

Practical algorithm for selection of candidates on respiratory support. LTx: lung transplantation; ICU: intensive care unit; HFNC: high-flow nasal cannula; MV: mechanical ventilation; ECMO: extracorporeal membrane oxygenation; BMI: body mass index; FU: follow-up.

Figure 2.

(A) Venovenous extracorporeal membrane oxygenation (ECMO), femoral vein for drainage (black arrow) and internal jugular vein for inflow (dotted arrow). (B) Venoarterial ECMO, femoral vein for drainage and femoral artery for inflow.