Perioperative fluid management for lung transplantation is challenging

Abstract

Lung transplantation is the definitive end-stage treatment for many lung diseases, and postoperative pulmonary oedema severely affects survival after lung transplantation. Optimizing perioperative fluid management can reduce the incidence of postoperative pulmonary oedema and improve the prognosis of lung transplant patients by removing the influence of patient, donor's lung and ECMO factors. Therefore, this article reviews seven aspects of lung transplant patients' pathophysiological characteristics, physiological characteristics of fluids, the influence of the donor lung on pulmonary oedema as well as current fluid rehydration concepts, advantages or disadvantages of intraoperative monitoring tools or types of fluids on postoperative pulmonary oedema, while showing the existing challenges in section 7. The aim is to show the specificity of perioperative fluid management in lung transplant patients and to provide new ideas for individualised fluid management in lung transplantation.

Keywords: Anaesthetic management; Fluid management; Lung transplantation; Monitors; Pulmonary oedema.

Fig. 1

Schematic diagram of alveolar-fluid homeostasis in the lung donor. There are many factors that can upset this balance which increase alveolar fluid such as time away from the donor lung; trauma; infection and overload. The alveolar fluid clearance capacity is also important in maintaining this balance by inhibiting this capacity in times of hypoxia. However, some drugs can enhance this capacity, such as catecholamines vasopressin, dexmedetomidine and PCTR1. This image was painted using Biorender online software.