Mechanical ventilation for the lung transplant recipient

Mechanical ventilation (MV) is an important aspect in the intraoperative and early postoperative management of lung transplant (LTx) recipients. There are no randomizedcontrolled trials of LTx recipient MV strategies; however, there are LTx center experiences and international survey studies reported. The main early complication of LTx is primary graft dysfunction (PGD), which is similar to the adult respiratory distress syndrome (ARDS). We aim to summarize information pertinent to LTx-MV, as well as PGD, ARDS, and intraoperative MV, and to synthesize these available data into recommendations. Based on the available evidence, we recommend lung-protective MV with low tidal volumes (<= 6 mL/kg predicted body weight [PBW]) and positive end-expiratory pressure for the LTx recipient. In our opinion, theMV strategy should be based on donor characteristics (donor PBW as a parameter of actual allograft size), rather than based on recipient characteristics; however, this donor characteristics-based protective MVis based on indirect evidence and requires validation in prospective clinical studies.