• Roland Tomasi, David Betz, Sophie Schlager, Tobias Kammerer, Dominik J Hoechter, Thomas Weig, Peter Slinger, Laura V Klotz, Bernhard Zwißler, Nandor Marczin, and von Dossow Vera V Department of Anesthesiology, Ludwig-Maximilians-University of Munich, Munich, Germany..
• Department of Anesthesiology, Ludwig-Maximilians-University of Munich, Munich, Germany. Electronic address: roland.tomasi@med.uni-muenchen.de.
• J. Cardiothorac. Vasc. Anesth. 2018 Feb 1; 32 (1): 62-69.

ObjectiveAlthough increasing evidence in lung transplantation (LTx) suggests that intraoperative management could influence outcomes, there are no guidelines available regarding intraoperative management of LTx. The overall goal of the study was to assess geographic and center volume-specific clinical practices in perioperative management.DesignProspective data analysis.SettingOnline survey from a single-center university hospital.ParticipantsEuropean and non-European LTx centers.InterventionsAn online survey was sent to 176 centers currently performing LTx procedures. It covered organizational data, general anesthesia considerations, fluid therapy and coagulation, antioxidant and anti-inflammatory therapies, and ventilation strategies.Measurements And Main ResultsThe response rates were 57.5% (n = 42) from European and 32% (n = 33) from non-European countries. Significant differences between European and non-European countries were use of volatile hypnotics (p = 0.016), use of sufentanil (p < 0.001), inotropic agents (p = 0.001) and colloid infusion (p < 0.001), use of calibrated pulse contour analysis (p = 0.004), use of intraoperative traditional laboratory-based coagulation tests (p = 0.001) and platelet function analysis (p = 0.005), and use of higher peak inspiratory pressure (p = 0.009). Center volume-specific differences were use of fentanyl (p = 0.03) and the use of higher peak inspiratory pressure (p = 0.005) for ventilation. Induction of anesthesia and use of advanced hemodynamic monitoring, therapy for pulmonary hypertension, antioxidant and anti-inflammatory therapies, and ventilation strategies were not different among the centers.ConclusionsThis survey demonstrated for the first time statistically significant differences among European and non-European centers and among low- versus high-volume centers regarding intraoperative management during LTx. These observations will be of some guidance for the LTx community and may trigger more extensive studies.Copyright © 2018 Elsevier Inc. All rights reserved.

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