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Non-Invasive Ventilatory Support Tool as a Bridge in Lung Transplants—Practical Approach and Clinical Evaluation

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Guest Editor
Intensive Care Unit, Hospital Morales Meseguer, 30007 Murcia, Spain
Interests: mechanical ventilation; critical care medicine; weaning mechanical ventilation; non invasive ventilation
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Special Issue Information

Dear Colleagues,

There is reat interest in the development of a non-invasive ventilatory support program in patients who are candidates for a lung transplant. This pre-transplant ventilatory approach entails great knowledge of the non-invasive ventilatory support options (non-invasive, nasal high-flow oxygen, negative non-invasive ventilation); these options are essential for a safe bridge to lung transplant. In this Special Issue, we will cover the role of noninvasive ventilatory approaches, methodology aspects, health care programs in candidate for lung transplants to avoiding intubation, improving lung function, and all aspects in the post-transplant period, facilitating extubation, protocols for preventing complications, supporting physiotherapy and recommendation for managing post-reimplantation syndrome.

Dr. Antonio Matías Esquìnas
Guest Editor

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Keywords

  • non-invasive ventilation
  • lung transplant
  • pre-transplant support
  • post-transplant care

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Published Papers (1 paper)

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Review

11 pages, 247 KB  
Review
High-Flow Nasal Cannula in Patients Awaiting Lung Transplant: Evidence, Clinical Applications, and Outcomes
by Salah M. Zeineldine, Rami Hallak, Antonio Esquinas and Mohamad F. El-Khatib
Adv. Respir. Med. 2026, 94(2), 21; https://doi.org/10.3390/arm94020021 - 30 Mar 2026
Viewed by 510
Abstract
Patients with end-stage lung diseases awaiting lung transplant frequently experience severe hypoxemia, dyspnea, and functional limitations that may compromise survival and transplant eligibility. Optimizing noninvasive respiratory support during the waiting period is crucial to preserve oxygenation, maintain physical conditioning, and avoid escalation to [...] Read more.
Patients with end-stage lung diseases awaiting lung transplant frequently experience severe hypoxemia, dyspnea, and functional limitations that may compromise survival and transplant eligibility. Optimizing noninvasive respiratory support during the waiting period is crucial to preserve oxygenation, maintain physical conditioning, and avoid escalation to invasive mechanical ventilation, which is associated with poorer transplant outcomes. High-flow nasal cannula therapy has emerged as an important noninvasive respiratory support modality capable of providing physiological and clinical benefits such as precise fractions of inspired oxygen, a low level of positive end-expiratory pressure, dead-space washout, and reduced work of breathing. This review summarizes the pathophysiology of hypoxemia in lung transplant candidates, the mechanisms of action of high-flow nasal cannulas, and the current clinical evidence supporting its use in this population during the pre-transplant period. Available evidence suggests that the use of high-flow nasal cannulas improves oxygenation, relieves dyspnea, enhances exercise tolerance, facilitates participation in pulmonary rehabilitation programs, and may reduce the need for endotracheal intubation, thereby improving the likelihood of survival to transplantation. The review also discusses patient selection, the practical implementation of high-flow nasal cannula therapy, and comparisons with other respiratory support modalities. Although the current evidence is largely observational and heterogenous, high flow appears to be a valuable supportive and bridging therapy for selected patients awaiting lung transplant. Future prospective studies are needed to define standardized protocols and evaluate transplant-specific outcomes. Full article
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