Introduction: To explore the hypothesis that early ventilation strategies influence clinical outcomes in lung transplantation,
we have examined our routine ventilation practices in terms of tidal volumes (Vt) and inflation pressures.
Methods: A total of 124 bilateral lung transplants between 2010 and 2013 were retrospectively assigned to low
(b6 mL/kg), medium (6-8 mL/kg), and high (N8 mL/kg) Vt groups based on ventilation characteristics during
the first 6 hours after surgery. Those same 124 patients were also stratified to low-pressure (b25 cm H2O) and
high-pressure (≥25 cm H2O) groups.
Results: Eighty percent of patients were ventilated using pressure control mode. Low, medium, and high Vt were
applied to 10%, 43%, and 47% of patients, respectively. After correcting for patients requiring extracorporeal support,
there was no difference in short-term to midterm outcomes among the different Vt groups. Low inflation
pressures were applied to 61% of patients, who had a shorter length of intensive care unit stay (5 vs 12 days;
P = .012), higher forced expiratory volume in 1 second at 3 months (77.8% vs 60.3%; P b .001), and increased
6-month survival rate (95% vs 77%; P = .008).
Conclusion: Low Vt ventilation has not been fully adopted in our practice. Ventilation with higher inflation pressures,
but not Vt, was significantly associated with poorer outcomes after lung transplantation.