Bronchoscopic survillance during early postoperative period after lung transplantation

Background: Lung transplant has become an accepted modality of treatment of patients with end stage pulmonary disease, establishing protocols for improving survival in these patients is the need of the hour. The aim of this study was to assess the use of bronchoscopic surveillance during early post-operative period after lung transplantation.Methods: It is a hospital based retrospective study; the study was carried out in a lung transplant centre located in Chennai, India.  A total of eight cases of single lung transplantation were done during the period of one year. Six patients were selected based on the inclusion criteria and the use of bronchoscopy during the immediate post-operative period followed by bronchoscopy during the early hours of everyday for the first week and the success in reduction of immediate post-operative infection and observations has been analysed.Results: In analysis of all the six cases, the positive signs of early morning bronchoscopy done were identified, mucus plugs which contribute to significant hypoxemia and morbidity were not observed in any of the patients.  New patch was also not observed in any of these patients. Culture positivity from the donor lung carrying over to the recipient was observed in just one of these patients.Conclusions: This protocol based frequent bronchoscopy prevents ‘Surprise’ patches in the lungs. Performance of Broncho Alveolar Lavage on a regular basis avoided the possibility of infections developing by early screening and aided as a tool for identification of acute neo lung rejection.

Predictors of Nocturnal Oxygen Desaturation in Normoxemic Patients with Moderate to Very Severe Chronic Obstructive Pulmonary Disease.

Introduction: COPD is associated with complications suchas reduced oxygen saturation and hypoventilation duringsleep and is underdiagnosed among normoxemic patients. Toidentify the daytime parameters to predict nocturnal oxygendesaturation in normoxemic patients with moderate to verysevere chronic obstructive pulmonary disease. To correlate thepresence of nocturnal oxygen desaturation with pulmonaryhypertension.Material and methods: A cross-sectional study wasperformed at ACS medical college Chennai for 14 monthsfrom May 2017 to June 2018. The study population included103 participants. Data on variables such as 6-minute walk test,spirometry, nocturnal oximetry, partial pressures of O2 andCO2 were assessed.Results: A total of 103 patients were included in the analysiswith 93.2% males and 3.9% current smokers and 87.4%ex-smokers. 52.4% had a normal chest X-ray. Around45.6% had hyperinflated lungs. In the 6 minutes-walktest, 32% participants had desaturation. 50.5% had positiveC-reactive protein levels indicating the presence of systemicinflammation. Right atrial/right ventricular dilatation wasnoted among 34% participants. Nocturnal desaturation with3 to 4 episodes/hour was present among 39% participants.Univariate analysis results show that post FEV 1, partialpressure of oxygen and carbon dioxide, presence ofdesaturation and RA/RV dilatation on echocardiography wereall statistically significant predictors of nocturnal oxygendesaturation in normoxemic patients with moderate to verysevere Chronic Obstructive Lung Disease.Conclusion: Screening the COPD patients for these daytimepredictors will enable in identifying the patients who havenocturnal desaturation. This in turn will aid in early initiationof home oxygen therapy.