Impact of Prone Positioning after Lung Transplantation - A Single Center Experience

Abstract

Purpose Prone positioning has become a standard therapy in acute respiratory distress syndrome with improved oxygenation and decreased mortality. The aim of this study was to evaluate the potential benefit of prone positioning after lung transplantation (LTx) in patients with impaired gas exchange in the early postoperative period. Methods We retrospectively analyzed LTx recipients transplanted between 01/2014 and 12/2019 (n=553). Demographics and clinical data of these patients were collected. A subgroup analysis was performed for patients who were placed in prone position on prolonged extracorporeal membrane oxygenation (ECMO). Results During the study period 155 (28%) patients were placed in prone position immediately after LTx for a median of 19 (15-26) hours. Patients requiring prone positioning were mainly suffering from idiopathic pulmonary fibrosis (IPF) with a mean age of 44.3 (±1.4) years. Before prone position, median PO2/FiO2 (P/F ratio) was 179 (120-280) mmHg and median dynamic lung compliance (Cdyn) was 24.1 (18.3-30.6) ml/cmH2O. Both parameters significantly increased after proning - median P/F ratio increased to 353 (255-414; p Conclusion Prone positioning significantly improved oxygenation in LTx recipients with a complex immediate postoperative course. Placing a patient with prolonged ECMO support in prone positioning is feasible and safe.