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Respiratory Failure and ARDS

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Abstract

Pulmonary complications are common in the period immediately after liver transplantation (LT) to the point that they are almost an expected consequence of the procedure. Approximately one-fifth of patients with end-stage liver disease are hypoxemic prior to transplantation and the hypoxemia may worsen in the post-operative period due to alterations of respiratory mechanics. The published prevalence of pleural effusion, atelectasis and interstitial pulmonary edema is up to 87 % [1, 2]. Fortunately the majority of cases are of little clinical consequence as resolution occurs rapidly without the need for complex intervention and without adversely affecting outcome [1].

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References

  1. Golfieri R, Giampalma E, Morselli Labate AM et al (2000) Pulmonary complications of liver transplantation: radiological appearance and statistical evaluation of risk factors in 300 cases. Eur Radiol 10:1169–83

    Article  PubMed  CAS  Google Scholar 

  2. Hong SK, Hwang S, Lee SG et al (2006) Pulmonary complications following adult liver transplantation. Transplant Proc 38:2979–81

    Article  PubMed  CAS  Google Scholar 

  3. Ammori JB, Pelletier SJ, Lynch R et al (2008) Incremental costs of post-liver transplantation complications. J Am Coll Surg 206:89–95

    Article  PubMed  Google Scholar 

  4. Garcia N Jr, Mihas AA (2004) Hepatic hydrothorax: pathophysiology, diagnosis, and management. J Clin Gastroenterol 38:52–8

    Article  PubMed  Google Scholar 

  5. Mandell MS, Campsen J, Zimmerman M et al (2009) The clinical value of early extubation. Curr Opin Organ Transplant 14:297–302

    Article  PubMed  Google Scholar 

  6. Steadman RH (2007) Con: immediate extubation for liver transplantation. J Cardiothorac Vasc Anesth 21:756–7

    Article  PubMed  Google Scholar 

  7. Ozier Y, Klinck JR (2008) Anesthetic management of hepatic transplantation. Curr Opin Anaesthesiol 21:391–400

    Article  PubMed  Google Scholar 

  8. Myles PS, Daly DJ, Djaiani G et al (2003) A systematic review of the safety and effectiveness of fast-track cardiac anesthesia. Anesthesiology 99:982–7

    Article  PubMed  Google Scholar 

  9. Campos JH (2009) Fast track in thoracic anesthesia and surgery. Curr Opin Anaesthesiol 22:1–3

    Article  PubMed  Google Scholar 

  10. Findlay JY, Jankowski CJ, Vasdev GM et al (2002) Fast track anesthesia for liver transplantation reduces postoperative ventilation time but not intensive care unit stay. Liver Transpl 8:670–5

    Article  PubMed  Google Scholar 

  11. Mandell MS, Lezotte D, Kam I, Zamudio S (2002) Reduced use of intensive care after liver transplantation: patient attributes that determine early transfer to surgical wards. Liver Transpl 8:682–7

    Article  PubMed  Google Scholar 

  12. Xia VW, Taniguchi M, Steadman RH (2008) The changing face of patients presenting for liver transplantation. Curr Opin Organ Transplant 13:280–4

    Article  PubMed  Google Scholar 

  13. Mandell MS, Stoner TJ, Barnett R et al (2007) A multicenter evaluation of safety of early extubation in liver transplant recipients. Liver Transpl 13:1557–63

    Article  PubMed  Google Scholar 

  14. Biancofiore G, Romanelli AM, Bindi ML et al (2001) Very early tracheal extubation without predetermined criteria in a liver transplant recipient population. Liver Transpl 7:777–82

    Article  PubMed  CAS  Google Scholar 

  15. Glanemann M, Hoffmeister R, Neumann U et al (2007) Fast tracking in liver transplantation: which patient benefits from this approach? Transplant Proc 39:535–6

    Article  PubMed  CAS  Google Scholar 

  16. Carton EG, Rettke SR, Plevak DJ et al (1994) Perioperative care of the liver transplant patient: Part 1. Anesth Analg 78:120–33

    PubMed  CAS  Google Scholar 

  17. Carton EG, Plevak DJ, Kranner PW et al (1994) Perioperative care of the liver transplant patient: Part 2. Anesth Analg 78:382–99

    Article  PubMed  CAS  Google Scholar 

  18. Faenza S, Ravaglia MS, Cimatti M et al (2006) Analysis of the causal factors of prolonged mechanical ventilation after orthotopic liver transplant. Transplant Proc 38:1131–4

    Article  PubMed  CAS  Google Scholar 

  19. MacIntyre NR, Cook DJ, Ely EW Jr et al (2001) Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 120(6 Suppl):375S–95

    Article  PubMed  CAS  Google Scholar 

  20. Boles JM, Bion J, Connors A et al (2007) Weaning from mechanical ventilation. Eur Respir J 29:1033–56

    Article  PubMed  Google Scholar 

  21. Esteban A, Alia I, Tobin MJ et al (1999) Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 159:512–8

    PubMed  CAS  Google Scholar 

  22. Eskandar N, Apostolakos MJ (2007) Weaning from mechanical ventilation. Crit Care Clin 23:263–74

    Article  PubMed  Google Scholar 

  23. Brochard L, Thille AW (2009) What is the proper approach to liberating the weak from mechanical ventilation? Crit Care Med 37(10 Suppl):S410–5

    Article  PubMed  Google Scholar 

  24. Burns KE, Adhikari NK, Keenan SP, Meade M (2009) Use of non-invasive ventilation to wean critically ill adults off invasive ventilation: meta-analysis and systematic review. BMJ 338:b1574

    Article  PubMed  Google Scholar 

  25. Epstein SK (2009) Weaning from ventilatory support. Curr Opin Crit Care 15:36–43

    Article  PubMed  Google Scholar 

  26. Girard TD, Ely EW (2008) Protocol-driven ventilator weaning: reviewing the evidence. Clin Chest Med 29:241–52

    Article  PubMed  Google Scholar 

  27. MacIntyre N (2007) Discontinuing mechanical ventilatory support. Chest 132:1049–56

    Article  PubMed  Google Scholar 

  28. Mauri T, Pivi S, Bigatello LM (2008) Prolonged mechanical ventilation after critical illness. Minerva Anestesiol 74:297–301

    PubMed  CAS  Google Scholar 

  29. Ely EW, Meade MO, Haponik EF et al (2001) Mechanical ventilator weaning protocols driven by nonphysician health-care professionals: evidence-based clinical practice guidelines. Chest 120(6 Suppl):454S–63

    Article  PubMed  CAS  Google Scholar 

  30. Frustos-Vivar F, Esteban A, Paezteguia C, Anzueto A et al (2005) Outcome of mechanically ventilated patients who require a tracheostomy. Crit Care Med 33:290–8

    Article  Google Scholar 

  31. King C, Moores LK (2008) Controversies in mechanical ventilation: when should a tracheotomy be placed? Clin Chest Med 29:253–63

    Article  PubMed  Google Scholar 

  32. Pirat A, Zeyneloglu P, Candan S et al (2004) Percutaneous dilational tracheotomy in solid-organ transplant recipients. Transplant Proc 36:221–3

    Article  PubMed  CAS  Google Scholar 

  33. Resar R, Pronovost P, Haraden C, Simmonds T, Rainey T, Nolan T (2005) Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Jt Comm J Qual Patient Saf 31:243–8

    PubMed  Google Scholar 

  34. Dodek P, Keenan S, Cook D et al (2004) Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med 141:305–13

    PubMed  Google Scholar 

  35. Rello J, Lode H, Cornaglia G, Masterton R (2010) A European care bundle for prevention of ventilator-associated pneumonia. Intensive Care Med 36:773–80

    Article  PubMed  Google Scholar 

  36. Jacobi J, Fraser GL, Coursin DB et al (2002) Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 30:119–41

    Article  PubMed  Google Scholar 

  37. Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–7

    Article  PubMed  CAS  Google Scholar 

  38. Kress JP, Gehlbach B, Lacy M et al (2003) The long-term psychological effects of daily sedative interruption on critically ill patients. Am J Respir Crit Care Med 168:1457–61

    Article  PubMed  Google Scholar 

  39. Kress JP, Vinayak AG, Levitt J et al (2007) Daily sedative interruption in mechanically ventilated patients at risk for coronary artery disease. Crit Care Med 35(2):365–71

    Article  PubMed  Google Scholar 

  40. Girard TD, Kress JP, Fuchs BD et al (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 371:126–34

    Article  PubMed  Google Scholar 

  41. Nava S, Hill N (2009) Non-invasive ventilation in acute respiratory failure. Lancet 374(9685):250–9

    Article  PubMed  Google Scholar 

  42. Ferrer M (2005) Non-invasive ventilation as a weaning tool. Minerva Anestesiol 71(6):243–7

    PubMed  CAS  Google Scholar 

  43. Antonelli M, Conti G, Bufi M et al (2000) Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. JAMA 283:235–41

    Article  PubMed  CAS  Google Scholar 

  44. Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903

    PubMed  Google Scholar 

  45. Aduen JF, Stapelfeldt WH, Johnson MM et al (2003) Clinical relevance of time of onset, duration, and type of pulmonary edema after liver transplantation. Liver Transpl 9:764–71

    Article  PubMed  Google Scholar 

  46. Snowden CP, Hughes T, Rose J, Roberts DR (2000) Pulmonary edema in patients after liver transplantation. Liver Transpl 6:466–70

    Article  PubMed  CAS  Google Scholar 

  47. Yost CS, Matthay MA, Gropper MA (2001) Etiology of acute pulmonary edema during liver transplantation: a series of cases with analysis of the edema fluid. Chest 119:219–23

    Article  PubMed  CAS  Google Scholar 

  48. Mueller AR, Platz KP, Haak M et al (1996) The release of cytokines, adhesion molecules, and extracellular matrix parameters during and after reperfusion in human liver transplantation. Transplantation 62:1118–26

    Article  PubMed  CAS  Google Scholar 

  49. Sampathkumar P, Lerman A, Kim BY et al (1998) Post-liver transplantation myocardial dysfunction. Liver Transpl Surg 4:399–403

    Article  PubMed  CAS  Google Scholar 

  50. Krowka MJ, Porayko MK, Plevak DJ et al (1997) Hepatopulmonary syndrome with progressive hypoxemia as an indication for liver transplantation: case reports and literature review. Mayo Clin Proc 72:44–53

    Article  PubMed  CAS  Google Scholar 

  51. Gupta S, Castel H, Rao RV et al (2010) Improved survival after liver transplantation in patients with hepatopulmonary syndrome. Am J Transplant 10(2):354–63

    Article  PubMed  CAS  Google Scholar 

  52. Roma J, Balbi E, Pacheco-Moreira L et al (2010) Methylene blue used as a bridge to liver transplantation postoperative recovery: a case report. Transplant Proc 42:601–4

    Article  PubMed  CAS  Google Scholar 

  53. Deberaldini M, Arcanjo AB, Melo E et al (2008) Hepatopulmonary syndrome: morbidity and survival after liver transplantation. Transplant Proc 40:3512–6

    Article  PubMed  CAS  Google Scholar 

  54. Taille C, Cadranel J, Bellocq A, et al. Liver transplantation for hepatopulmonary syndrome: a ten-year experience in Paris, France. Transplantation. 2003;75:1482–9; discussion 46–7.

    Google Scholar 

  55. Swanson KL, Wiesner RH, Nyberg SL et al (2008) Survival in portopulmonary hypertension: Mayo Clinic experience categorized by treatment subgroups. Am J Transplant 8:2445–53

    Article  PubMed  CAS  Google Scholar 

  56. Bozbas SS, Eyuboglu FO, Arslan NG et al (2009) The prevalence and the impact of portopulmonary hypertension on postoperative course in patients undergoing liver transplantation. Transplant Proc 41:2860–3

    Article  PubMed  CAS  Google Scholar 

  57. Ramsay M (2010) Portopulmonary hypertension and right heart failure in patients with cirrhosis. Curr Opin Anaesthesiol 23:145–50

    Article  PubMed  Google Scholar 

  58. Wheeler AP, Bernard GR (2007) Acute lung injury and the acute respiratory distress syndrome: a clinical review. Lancet 369(9572):1553–64

    Article  PubMed  Google Scholar 

  59. Ware LB, Matthay MA (2000) The acute respiratory distress syndrome. N Engl J Med 342:1334–49

    Article  PubMed  CAS  Google Scholar 

  60. Triulzi DJ (2009) Transfusion-related acute lung injury: current concepts for the clinician. Anesth Analg 108:770–6

    Article  PubMed  Google Scholar 

  61. Sachdeva A, Matuschak GM (2008) Diffuse alveolar hemorrhage following alemtuzumab. Chest 133:1476–8

    Article  PubMed  Google Scholar 

  62. The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–8

    Article  Google Scholar 

  63. Putensen C, Theuerkauf N, Zinserling J et al (2009) Meta-analysis: ventilation strategies and outcomes of the acute respiratory distress syndrome and acute lung injury. Ann Intern Med 151:566–76

    PubMed  Google Scholar 

  64. Brower RG, Lanken PN, MacIntyre N et al (2004) Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 351:327–36

    Article  PubMed  Google Scholar 

  65. Villar J, Kacmarek R, Perez-Mendez L, Aguirre-Jaime A (2006) A high positive-end expiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized control trial. Crit Care Med 34:1311–8

    Article  PubMed  Google Scholar 

  66. Saner FH, Olde Damink SW, Pavlakovic G et al (2008) Positive end-expiratory pressure induces liver congestion in living donor liver transplant patients: myth or fact. Transplantation 85:1863–6

    Article  PubMed  Google Scholar 

  67. Saner FH, Pavlakovic G, Gu Y et al (2006) Does PEEP impair the hepatic outflow in patients following liver transplantation? Intensive Care Med 32:1584–90

    Article  PubMed  Google Scholar 

  68. Saner FH, Pavlakovic G, Gu Y et al (2006) Effects of positive end-expiratory pressure on systemic haemodynamics, with special interest to central venous and common iliac venous pressure in liver transplanted patients. Eur J Anaesthesiol 23:766–71

    Article  PubMed  CAS  Google Scholar 

  69. Fan E, Wilcox ME, Brower RG et al (2008) Recruitment maneuvers for acute lung injury: a systematic review. Am J Respir Crit Care Med 178:1156–63

    Article  PubMed  Google Scholar 

  70. Kavanagh BP, Laffey JG (2006) Hypercapnia: permissive and therapeutic. Minerva Anestesiol 72:567–76

    PubMed  CAS  Google Scholar 

  71. Derdak S, Mehta S, Stewart TE et al (2002) High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. Am J Respir Crit Care Med 166:801–8

    Article  PubMed  Google Scholar 

  72. Siau C, Stewart TE. Current role of high frequency oscillatory ventilation and airway pressure release ventilation in acute lung injury and acute respiratory distress syndrome. Clin Chest Med. 2008;29:265–75, vi.

    Google Scholar 

  73. Gattinoni L, Tognoni G, Pesenti A et al (2001) Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 345:568–73

    Article  PubMed  CAS  Google Scholar 

  74. Sykes E, Cosgrove JF, Nesbitt ID, O’Suilleabhain CB (2007) Early noncardiogenic pulmonary edema and the use of PEEP and prone ventilation after emergency liver transplantation. Liver Transpl 13:459–62

    Article  PubMed  CAS  Google Scholar 

  75. Griffiths MJ, Evans TW (2005) Inhaled nitric oxide therapy in adults. N Engl J Med 353:2683–95

    Article  PubMed  CAS  Google Scholar 

  76. Jain R, DalNogare A (2006) Pharmacological therapy for acute respiratory distress syndrome. Mayo Clin Proc 81:205–12

    Article  PubMed  CAS  Google Scholar 

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Correspondence to James Y. Findlay .

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Findlay, J.Y., Keegan, M.T. (2012). Respiratory Failure and ARDS. In: Wagener, G. (eds) Liver Anesthesiology and Critical Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5167-9_34

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  • DOI: https://doi.org/10.1007/978-1-4614-5167-9_34

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