CHEST Guidelines-Mechanical-Ventilation-After-Lung-Transplantation

Mechanical-Ventilation-After-Lung-Transplantation_

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The document discusses two primary topics related to medical research: one focused on obstructive sleep apnea (OSA) and pulmonary embolism (PE), and the other related to ventilation strategies after lung transplantation.<br /><br />In the first section, researchers explore the link between OSA and PE recurrence. They report that D-dimer levels, which are indicators of clotting activity and thus a risk factor for PE recurrence, are elevated in OSA patients. However, initial analyses did not show a significant difference in D-dimer levels between patients with and without recurrent PE. This finding highlights that, once adjusted for apnea-hypopnea index (AHI), D-dimer remains a significant risk factor. Additionally, the study presents CT90, a measure of the percentage of sleep time with blood oxygen saturation below 90%, as an independent protective factor against PE recurrence. This could indicate that CT90 helps differentiate between types of hypoxia which contributes to hypercoagulability in OSA patients.<br /><br />The second section addresses issues around mechanical ventilation after lung transplantation. The authors critique existing ventilation strategies used post-transplant, suggesting that current guidelines may allow for pressures that are too high. They argue that pressures should be significantly reduced for improved outcomes, and present data suggesting that lower inspiratory pressures provide a survival benefit. They call for more definitive trials concerning protective ventilation strategies, mentioning that they might need to shift current dogmas to set a lower threshold for pressure settings. Their analysis suggests that accepting higher positive end-expiratory pressure (PEEP) levels or significantly limiting inspiratory pressures may be needed, possibly complementing invasive support like extracorporeal support to protect grafts from ventilation-induced damage.

Keywords

obstructive sleep apnea

pulmonary embolism

D-dimer levels

apnea-hypopnea index

CT90

lung transplantation

mechanical ventilation

positive end-expiratory pressure

inspiratory pressures

extracorporeal support