Feltracco P, Serra E, Barbieri S, Persona P, Rea F, Loy M, Ori C. Clin Transplant. 2009 Sep-Oct;23(5):748-50.
This case report described the clinical course of two patients that suffered from refractory hypoxemia caused by the post-reimplantation syndrome treated with NIV in the prone and Trendelenburg positions. The first case report was characterised by a 37-year old woman undergoing bilateral sequential single lung transplant (BSSLT), as a consequence of end stage respiratory failure. She was extubated a few hours after arriving to the ICU and subsequently developed extensive patchy alveolar consolidations in the dorsal and basal regions of the lungs. Due to unresponsive hypoxia, despite the treatment with high oxygen using a face mask, the patient was treated with NIV through respiratory helmet. This approach in conjunction with alternating between the prone and the Trendelenburg positions, improved the patient's condition. Moreover, the implanted lungs were better filled with air and further improvements of oxygenation allowed the removal of the helmet. In the second case, a 44-year-old man with cystic fibrosis underwent BSSLT due to end-stage respiratory failure. Several hours after arriving in the ICU the patient was extubated, but due to increased oxygen desaturation he was treated with facemask delivered NIV. His gas exchange deteriorated as a consequence of lung infiltrations and atelectasis of the lower lobes. Similar to the first case, the implementation of the mask NIV delivery and change in position lead to the improvement of the patient's condition. Therefore, the results from these two case studies show that the use of helmet or facemask NIV in conjunction with position changes represents a valuable approach in patients that have undergone lung transplantation.
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