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Intensive care management of heart, lung, and heart–lung transplant recipients 

Intensive care management of heart, lung, and heart–lung transplant recipients
Chapter:
Intensive care management of heart, lung, and heart–lung transplant recipients
Author(s):

Andrew C. Steel

DOI:
10.1093/med/9780199651429.003.0033
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date: 23 August 2019

The intensive care management of recipients of heart, heart–lung, and lung transplants is undertaken by physicians who practice in highly specialized and experienced transplant centres. However, as patients enjoy higher survival rates and quality of life post-transplant, the tenets of their management become increasingly important for the wider group of intensive care physicians, surgeons, and anaesthesiologists. This chapter highlights the following key points: as operative procedures become widely standardized, results of cardiothoracic transplantation are much more dependent on the non-operative treatment strategies applied during the immediate postoperative period; the quality of the communication and teamwork between members of the transplant team is crucial to the delivery of care; the essential approach to the management of the transplanted heart includes careful control of the preload and, crucially, understanding that the transplanted heart is without sympathetic, parasympathetic, or sensory enervation; ventilation management in the immediate postoperative period depends upon allograft function and the patient’s overall condition; however, fundamentally it should be a protective ventilation strategy aimed at supporting the patient and not normalizing physiological parameters; and the leading causes of morbidity and mortality in the first 30 days after transplantation are graft failure, multi-organ failure, infection, and renal failure.

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