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

Objective:To evaluate the clinical use of continuous positive airway pressu re (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 recipie nts between 1990 and 1996 at this institution (n = 102). Interventions: Postoperative pain was controlled by a thoracic epidural inf usion of bupivacaine, 1 mg/mL, and sufentanil, 1 mu g/mL. After extubation, CPAP, 5 to 10 cm H2O by face mask, was used to prevent reperfusion edema. Measurements and Main Results: In 99 patients, the length of ventilation (L OV) was a median of 4.3 hours (range, 1.0 to 312.0 hours). The median LOV w as 8.0 hours (range, 1.5 to 41.0 hours) in the heart-lung recipients, 4.5 h ours (range, 2.0 to 47.0 hours) in the bilateral-lung recipients, and 3.5 h ours (range, 1.0 to 312.0 hours) in the single-lung recipients. Three trans plant recipients, all with primary pulmonary hypertension, were prematurely extubated and reintubated because of pulmonary edema. Twelve hours after e xtubation, the median oxygenation index (PaO2/F1O2, PaO2 in kilopascal unit s) was greater than 35. The median ICU length of stay for all transplant re cipients 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. Copyright (C) 1999 by W.B. Saunders Company.