Evaluate function of the transplanted lung and other organ systems, especially those that may be compromised by immunosuppressant medications

Assess  the presence of infection or rejection

If single lung transplants: establish the extent of disease and degree of compromise of the native lung

Consider implications to the transplanteted lung of proposed surgical procedure

History

1. Symptoms: dyspnea, fatigue, fever, cough, sputum production, exercise tolerance, need for oxygen.

2. Hospitalizations, previous infections or allograft rejection.

3. Prolonged ventilator dependence or previous tracheostomy 

Physical evaluation:

1. Patient’s voice,  stridor or wheezing:  airway narrowing or compromise.

2. Scars of tracheostomy

Preparation:

1. If prolonged ventilator dependence or previous tracheostomy: possible subglottic stenosis, consider right size of endotracheal tube and/or fiberoptic intubation.

2. Referr to transplant pulmonologist if increased alveolar-arterial oxygen gradient or hypercapnia 

Laboratory investigations

1. Arterial blood gas analysis.
2. Complete blood count to rule out:infection, anemia, polycythemia.
3. Serum blood urea nitrogen, creatinine, and electrolytes ( immunosuppressants)
4. Serum glucose (steroids)
5. ECG:  right ventricular dysfunction, myocardial ischemia
6. Pulmonary function tests (compare with previous tests); search for rejection or infection if deteroiration
7. Chest radiograph to rule out infection or rejection

Premedication

Avoid anxiolytic premedication if patients with marginal gas exchange or CO2 retention.

Give sedatives  in a monitored setting.

Antisialogogue before airway inspection.

Steroid supplementation not for brief procedures

References