Fast-Tracking in Lung Transplantation

Abstract

Fast-tracking in cardiothoracic surgery is highly challenging. Early postoperative extubation an aspect of this strategy. The objective of the present study was to report our whole experience of immediate end-surgery extubation (OR extubation) after lung transplantation. This retrospective study was apporved by the Ethical Board of the French Society for Anesthesia and Intensive Care. All consecutive patients undergoing double-lung transplantation from 2012 to 2018 were analyzed, except repeated transplantation during the study period, and transplantation under cardiopulmonary bypass. The strategy is possible due to short acting drugs and a strict cardio-respiratory weaning protocol based on inhaled nitric oxyde and ECMO removale at end-surgery when is possible (see Figure). The aims of the study were: to identify predictive factors of immediate extubation, and to compare outcome among patients. 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. Immediate extubation via a fast-tracking protocol is feasible in one third of patients after lung transplantation. It requires transdisciplinary collaboration. It forecasts a positive outcome.