Management of Mechanical Ventilation

Mechanical ventilation in patients undergoing lung transplantation can result in air trapping due to incomplete exhalation, especially in patients with obstructive pulmonary disease. Significant air trapping may lead to increases in intrathoracic pressure and hemodynamic compromise because of a reduction in venous return. This problem can be diagnosed by disconnecting the patient from the breathing circuit for about 30 seconds; the blood pressure will returns to baseline if the cause of hemodynamic instability was hyperinflation of the lungs and air trapping. This is best treated with increasing expiratory time, resulting in hypoventilation and permissive hypercapnia, which is usually well tolerated as long as oxygenation can be maintained.

Mechanical ventilation with or without PEEP in any patient may lead to an increase in pulmonary vascular resistance. This may not be tolerated well in patients with right ventricular dysfunction. Increasing the volume status may not be the best intervention; inotropic support may have better results. The use of

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