ABSTRACT
Objective:To explore the safety and nosocomial infection control measures of COVID-19 patients of end-stage respiratory failure after lung transplantation.Methods:Lung transplantation was performed for a COVID-19 patient with end-stage respiratory failure after a negative conversion of 2019-nCoV nucleic acid. Before operation, all medical staff received simulated training on nosocomial infection. The procedures were performed in an operation room with a negative pressure environment. The three-grade preventive strategy was implemented and wearing positive pressure protective mask of electric air supply required. During operation, the patient was managed according to the in-hospital protection process. The environment and medical instruments were disinfected after operation.Results:The operation was completed successfully. The 2019-nCoV nucleic acid test was negative for many times after operation. Participants were placed in medical isolation for 14 days after surgery. During the period, nucleic acid test was negative twice.Conclusions:As an exploratory treatment, lung transplantation is a safe option for end-stage respiratory failure in COVID-19 in operation room with a negative pressure environment and implementations of three-grade preventive strategy.
ABSTRACT
Objective To evaluate the effect of fluid management guided by stroke volume variation (SVV) on postoperative outcomes of patients undergoing lung transplantation.Methods Thirty American Society of Anesthesiologists physical status Ⅲ or Ⅳ patients of both sexes,aged 51-78 yr,with body mass index of 18-25 kg/m2,undergoing elective double-lung transplantation,were randomized into 2 groups (n =15 each) using a random number table:SVV group and central venous pressure (CVP) group.SVV was maintained at 8％-13％ in groupSVV,and CVP at 8-12 cmH2O in group CVP.Mean arterial pressure,heart rate,CVP,cardiae output,pulmonary arterial pressure,SVV and systemic vascular resistance index were recorded at 30 min after anesthesia induction (T0),30 min of one-lung ventilation on one side (T1),30 min after pulmonary artery occlusion (T2),30 min after pulmonary artery unclamping (T3),30 min of one-lung ventilation on the eontralateral side (T4),30 min after pulmonary artery occlusion (T5),30 min after pulmonary artery unelamping (T6) and closing the chest (T7).The amount of vasoactive drugs consumed and net volume of fluid infused during each period were recorded.The oxygenation index and blood lactic acid concentrations were measured at each time point and 2 h following admission to intensive care unit (ICU) (T8).The extubation time and length of ICU stay were recorded,and the occurrence of complications was observed.Results Compared with group CVP,CVP at T2,3,5-6 and SVV at T7 were significantly increased,CVP at T7,pulmonary arterial pressure at T2,5,SVV at T2,3,5-6 and systemic vascular resistance index at T2-6 were decreased,the net volume of fluid infused during both pulmonary artery occlusion periods was increased,the net volume of fluid infused was reduced during the pulmonary artery unclamping periods,the consumption of norepinephrine was decreased,oxygenation index was increased at T3-4,6,8,blood lactic acid concentrations were decreased at T2-6,8,and the extubation time and length of ICU stay were shortened in group SVV (P＜0.05).There was no significant difference in the incidence of complications between the two groups (P＞0.05).Conclusion SVV-guided fluid management can promote postoperative outcomes of patients undergoing lung transplantation.