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The clinical course of anesthetic induction in lung transplant recipients with pulmonary complications after hematopoietic stem cell transplantation

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Abstract

Purpose

We examined the clinical course of anesthetic induction in lung transplant recipients with pulmonary complications after hematopoietic stem cell transplantation (post-HSCT), focusing on ventilatory management. We aimed to determine the incidence of oxygen desaturation during anesthetic induction and severe respiratory acidosis after anesthetic induction in post-HSCT lung transplant recipients, and to explore factors associated with their development.

Methods

Nineteen consecutive patients who underwent lung transplantation post-HSCT at Kyoto University Hospital (Japan) were retrospectively studied. Data regarding patient characteristics, preoperative examination, and clinical course during anesthetic induction were analyzed.

Results

The incidence of oxygen desaturation (SpO2 < 90 %) during anesthetic induction and severe respiratory acidosis (pH < 7.2) after anesthetic induction were 21.1 and 26.3 %, respectively. Reduced dynamic compliance (Cdyn) during mechanical ventilation was significantly associated with oxygen desaturation during anesthetic induction (p = 0.01), as well as severe respiratory acidosis after anesthetic induction (p = 0.01). The preoperative partial pressure of carbon dioxide in arterial blood (PaCO2; r = −0.743, p = 0.002) and body mass index (BMI; r = 0.61, p = 0.021) significantly correlated with Cdyn, and multivariate analysis revealed that both PaCO2 and BMI were independently associated with Cdyn.

Conclusions

Oxygen desaturation during anesthetic induction and severe respiratory acidosis after anesthetic induction frequently occur in post-HSCT lung transplant recipients. Low Cdyn may, at least partially, explain oxygen desaturation during anesthetic induction and severe respiratory acidosis after anesthetic induction. Moreover, preoperative hypercapnia and low BMI were predictive of low Cdyn.

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References

  1. Soubani AO, Uberti JP. Bronchiolitis obliterans following haematopoietic stem cell transplantation. Eur Respir J. 2007;29:1007–19.

    Article  CAS  PubMed  Google Scholar 

  2. Solh M, Arat M, Cao Q, Majhail NS, Weisdorf D. Late-onset noninfectious pulmonary complications in adult allogeneic hematopoietic cell transplant recipients. Transplantation. 2011;91:798–803.

    PubMed  Google Scholar 

  3. Au BK, Au MA, Chien JW. Bronchiolitis obliterans syndrome epidemiology after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2011;17:1072–8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Nakaseko C, Ozawa S, Sakaida E, Sakai M, Kanda Y, Oshima K, Kurokawa M, Takahashi S, Ooi J, Shimizu T, Yokota A, Yoshiba F, Fujimaki K, Kanamori H, Sakai R, Saitoh T, Sakura T, Maruta A, Sakamaki H, Okamoto S. Incidence, risk factors and outcomes of bronchiolitis obliterans after allogeneic stem cell transplantation. Int J Hematol. 2011;93:375–82.

    Article  PubMed  Google Scholar 

  5. Pechet TV, de le Morena M, Mendeloff EN, Sweet SC, Shapiro SD, Huddleston CB. Lung transplantation in children following treatment for malignancy. J Heart Lung Transplant. 2003;22:154–60.

    Article  PubMed  Google Scholar 

  6. Yamane M, Sano Y, Toyooka S, Okazaki M, Date H, Oto T. Living-donor lobar lung transplantation for pulmonary complications after hematopoietic stem cell transplantation. Transplantation. 2008;86:1767–70.

    Article  PubMed  Google Scholar 

  7. Chen F, Yamane M, Inoue M, Shiraishi T, Oto T, Minami M, Yanagisawa J, Fujinaga T, Shoji T, Toyooka S, Okumura M, Miyoshi S, Bando T, Date H. Less maintenance immunosuppression in lung transplantation following hematopoietic stem cell transplantation from the same living donor. Am J Transplant. 2011;11:1509–16.

    Article  CAS  PubMed  Google Scholar 

  8. Vogl UM, Nagayama K, Bojic M, Hoda MA, Klepetko W, Jaksch P, Dekan S, Siersch V, Mitterbauer M, Schellongowski P, Greinix HT, Petkov V, Schulenburg A, Kalhs P, Rabitsch W. Lung transplantation for bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation: a single-center experience. Transplantation. 2013;95:623–8.

    Article  PubMed  Google Scholar 

  9. Cheng GS, Edelman JD, Madtes DK, Martin PJ, Flowers ME. Outcomes of lung transplantation after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2014;20:1169–75.

    Article  PubMed  Google Scholar 

  10. Tokunaga K, Matsuzawa Y, Kotani K, Keno Y, Kobatake T, Fujioka S, Tarui S. Ideal body weight estimated from the body mass index with the lowest morbidity. Int J Obes. 1991;15:1–5.

    CAS  Google Scholar 

  11. Lemmens HJ, Brodsky JB, Bernstein DP. Estimating ideal body weight—a new formula. Obes Surg. 2005;15:1082–3.

    Article  PubMed  Google Scholar 

  12. Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL. CDC growth charts: United States. Adv Data. 2000;314:1–27.

    PubMed  Google Scholar 

  13. De Campos T. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The ARDS Network. N Engl J Med. 2000;342:1301–8.

    Article  Google Scholar 

  14. Quinlan JJ, Buffington CW. Deliberate hypoventilation in a patient with air trapping during lung transplantation. Anesthesiology. 1993;78:1177–81.

    Article  CAS  PubMed  Google Scholar 

  15. Myles PS, Ryder IG, Weeks AM, Williams T, Esmore DS. Case 1—1997 Diagnosis and management of dynamic hyperinflation during lung transplantation. J Cardiothorac Vasc Anesth. 1997;11:100–4.

    Article  CAS  PubMed  Google Scholar 

  16. Myles PS, Weeks AM, Buckland MR, Silvers A, Bujor M, Langley M. Anesthesia for bilateral sequential lung transplantation: experience of 64 cases. J Cardiothorac Vasc Anesth. 1997;11:177–83.

    Article  CAS  PubMed  Google Scholar 

  17. Enson Y, Giuntini C, Lewis ML, Morris TQ, Ferrer MI, Harvey RM. The influence of hydrogen ion concentration and hypoxia on the pulmonary circulation. J Clin Invest. 1964;43:1146–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Barer GR, Howard P, Shaw JW. Stimulus-response curves for the pulmonary vascular bed to hypoxia and hypercapnia. J Physiol. 1970;211:139–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Vizza CD, Lynch JP, Ochoa LL, Richardson G, Trulock EP. Right and left ventricular dysfunction in patients with severe pulmonary disease. Chest. 1998;113:576–83.

    Article  CAS  PubMed  Google Scholar 

  20. Chen F, Chin K, Ishii H, Kubo H, Miwa S, Ikeda T, Bando T, Date H. Continuous carbon dioxide partial pressure monitoring in lung transplant recipients. Ann Transplant. 2014;19:382–8.

    Article  PubMed  Google Scholar 

  21. Balick-Weber CC, Nicolas P, Hedreville-Montout M, Blanchet P, Stéphan F. Respiratory and hemodynamic effects of volume-controlled vs pressure-controlled ventilation during laparoscopy: a cross-over study with echocardiographic assessment. Br J Anaesth. 2007;99:429–35.

    Article  PubMed  Google Scholar 

  22. Jo YY, Kim JY, Kwak YL, Kim YB, Kwak HJ. The effect of pressure-controlled ventilation on pulmonary mechanics in the prone position during posterior lumbar spine surgery: a comparison with volume-controlled ventilation. J Neurosurg Anesthesiol. 2012;24:14–8.

    Article  PubMed  Google Scholar 

  23. Scohy TV, Bikker IG, Hofland J, de Jong PL, Bogers AJ, Gommers D. Alveolar recruitment strategy and PEEP improve oxygenation, dynamic compliance of respiratory system and end-expiratory lung volume in pediatric patients undergoing cardiac surgery for congenital heart disease. Paediatr Anaesth. 2009;19:1207–12.

    Article  PubMed  Google Scholar 

  24. Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ, Martin P, Chien J, Przepiorka D, Couriel D, Cowen EW, Dinndorf P, Farrell A, Hartzman R, Henslee-Downey J, Jacobsohn D, McDonald G, Mittleman B, Rizzo JD, Robinson M, Schubert M, Schultz K, Shulman H, Turner M, Vogelsang G, Flowers ME. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant. 2005;11:945–56.

    Article  PubMed  Google Scholar 

  25. Takeuchi Y, Miyagawa-Hayashino A, Chen F, Kubo T, Handa T, Date H, Haga H. Pleuroparenchymal fibroelastosis and non-specific interstitial pneumonia: frequent pulmonary sequelae of hematopoietic stem cell transplantation. Histopathology. 2015;66:536–44.

    Article  PubMed  Google Scholar 

  26. Bergeron A, Godet C, Chevret S, Lorillon G, Peffault de Latour R, de Revel T, Robin M, Ribaud P, Socié G, Tazi A. Bronchiolitis obliterans syndrome after allogeneic hematopoietic SCT: phenotypes and prognosis. Bone Marrow Transplant. 2013;48:819–24.

    Article  CAS  PubMed  Google Scholar 

  27. Littleton SW. Impact of obesity on respiratory function. Respirology. 2012;17:43–9.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Enago (http//www.enago.jp) for the English language review.

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Authors and Affiliations

  1. Department Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan

    Toshiyuki Mizota, Shino Matsukawa, Hiroshi Fukagawa, Hiroki Daijo, Tomoharu Tanaka & Kazuhiko Fukuda

  2. Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan

    Fengshi Chen & Hiroshi Date

Authors
  1. Toshiyuki Mizota
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  2. Shino Matsukawa
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  3. Hiroshi Fukagawa
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  4. Hiroki Daijo
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  5. Tomoharu Tanaka
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  6. Fengshi Chen
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  7. Hiroshi Date
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  8. Kazuhiko Fukuda
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Correspondence to Toshiyuki Mizota.

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Mizota, T., Matsukawa, S., Fukagawa, H. et al. The clinical course of anesthetic induction in lung transplant recipients with pulmonary complications after hematopoietic stem cell transplantation. J Anesth 29, 562–569 (2015). https://doi.org/10.1007/s00540-015-1986-z

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  • DOI: https://doi.org/10.1007/s00540-015-1986-z

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