The Hering-Breuer Reflex in Bilateral Lung Transplant Patients

Inclusion criteria

• Age >18 years;
• Both sexes;
• For group 1: patients admitted to the Intensive Care Unit after undergoing bilateral lung transplantation, during respiratory weaning;
• For group 2: patients admitted to the Intensive Care Unit for support or monitoring after non-thoracic surgery, who will arrive intubated.

Exclusion criteria

For group 1, patients meeting at least one of the following criteria will be excluded:

• Re-transplantation or single-lung transplantation;
• Urgent lung transplantation;
• Post-transplant respiratory system compliance < 30 mL/cmH₂O;
• Hemodynamic instability (defined as the presence of one or more of the following: plasma lactate > 4 mmol/L, need for vasoactive support with norepinephrine and/or epinephrine at a dose > 0.05 mcg/kg/min, systolic arterial pressure < 80 mmHg);
• Increased risk of bleeding related to the placement of a nasogastric tube due to coagulopathy or severe thrombocytopenia (INR > 2 and platelets < 70,000);
• Pregnancy

For group 2, patients presenting with one or more of the following criteria will be excluded:

• Postoperative respiratory system compliance < 30 mL/cmH₂O;
• Hemodynamic instability (defined as the presence of one or more of the following: plasma lactate > 4 mmol/L, need for vasoactive support with norepinephrine and/or epinephrine at a dose > 0.05 mcg/kg/min, systolic arterial pressure < 80 mmHg);
• Contraindications to nasogastric tube placement (gastroesophageal surgery within the last 3 months, gastroesophageal bleeding in the previous 30 days, esophageal varices, facial trauma);
• Increased risk of bleeding related to the placement of a nasogastric tube due to coagulopathy or severe thrombocytopenia (INR > 2 and platelets < 70,000);
• History of lung transplantation or major thoracic surgery;
• Pregnancy.