Regional Ventilation-Perfusion Matching by Electrical Impedance Tomography After Single Lung Transplant

Single lung transplantation (LUTX) can be the last therapeutic option for a growing cohort of patients suffering from end-stage respiratory failure. Postoperative ventilatory management of single LUTX recipients is challenged by the coexistence of the diseased native lung and a healthy-but fragile-graft. In this case report, in a single LUTX recipient with idiopathic pulmonary fibrosis, regional ventilation (V), perfusion (Q), and V/Q matching and subsequent measurement of shunt fraction (Qs/Qt) and alveolar dead space (Vd/Vt) were obtained by integrating electrical impedance tomography (EIT) with volumetric capnography and pulmonary thermodilution technique. Although the preoperative pulmonary scintigraphy showed predominant right lung perfusion (79.8% vs. 20.2%), the EIT documented the postoperative re-establishment of Q between the lungs (demonstrating the adequate functioning of vascular anastomoses), the diversion of V to the graft and similar global Qs/Qt (17%) and Vd/Vt (29%) between native and graft lung. Electrical impedance tomography mapping allowed regional Qs/Qt and Vd/Vt assessment: the native right lung had a completely deranged distribution of V and Q (Qs/Qt 25%, Vd/Vt 46%), whereas the graft showed normal coupling of V and Q (Qs/Qt 8%, Vd/Vt 12%). Electrical impedance tomography may allow noninvasive, repeatable, bedside assessments of the lung V/Q coupling after single LUTX.