The use of continuous positive airway pressure by face mask and thoracic epidural analgesia after lung transplantation

Abstract

Objective: To evaluate the clinical use of continuous positive airway pressure (CPAP) and thoracic epidural analgesia (TEA) after lung transplantation (LTx). Design: Retrospective case series. Setting: Cardiothoracic intensive care unit (ICU) at a university hospital. Participants: All heart-lung, bilateral, and single-lung transplant recipients between 1990 and 1996 at this institution (n = 102). Interventions: Postoperative pain was controlled by a thoracic epidural infusion of bupivacaine, 1 mg/mL, and sufentanil, 1 μg/mL. After extubation, CPAP, 5 to 10 cm H 2O by face mask, was used to prevent reperfusion edema. Measurements and Main Results: In 99 patients, the length of ventilation (LOV) was a median of 4.3 hours (range, 1.0 to 312.0 hours). The median LOV was 8.0 hours (range, 1.5 to 41.0 hours) in the heart-lung recipients, 4.5 hours (range, 2.0 to 47.0 hours) in the bilateral-lung recipients, and 3.5 hours (range, 1.0 to 312.0 hours) in the single-lung recipients. Three transplant recipients, all with primary pulmonary hypertension, were prematurely extubated and reintubated because of pulmonary edema. Twelve hours after extubation, the median oxygenation index (PaO 2/F 1O 2, PaO 2 in kilopascal units) was greater than 35. The median ICU length of stay for all transplant recipients was 4 days (range, 2 to 270 days). Conclusion: The postoperative use of CPAP and TEA is associated with early and safe tracheal extubation after LTx and may shorten ICU stay.