Abstract
IntroductionMany potential lung transplants are lost because of hypoxemia during donor management. We hypothesized that the apnea test, necessary to confirm the diagnosis of brain death in potential lung donors, was involved in the decrease in the ratio of partial pressure of arterial O2 to fraction of inspired O2 (PaO2/FiO2) and that a single recruitment maneuver performed just after the apnea test can reverse this alteration.MethodsIn this case-control study, we examined the effectiveness of the recruitment maneuver with a comparison cohort of brain dead patients who did not receive the maneuver. Patients were matched one-to-one on the basis of initial PaO2/FiO2 and on the duration of mechanical ventilation before the apnea test. PaO2/FiO2 was measured before (T1), at the end (T2) and two hours after apnea test (T3).ResultsTwenty-seven patients were included in each group. The apnea test was associated with a significant decrease in PaO2/FiO2 from 284 ± 98 to 224 ± 104 mmHg (P < 0.001). The decrease in PaO2/FiO2 between T1 and T3 was significantly lower in the recruitment maneuver group than in the control group (-4 (-68-57) vs -61 (-110--18) mmHg, P = 0.02). The number of potential donors with PaO2/FiO2 > 300 mmHg decreased by 58% (95% CI: 28-85%) in the control group vs 0% (95% CI: 0-34%) in the recruitment maneuver group (P < 0.001).ConclusionsThe apnea test induced a decrease in PaO2/FiO2 in potential lung donors. A single recruitment maneuver performed immediately after the apnea test can reverse this alteration and may prevent the loss of potential lung donors.
Highlights
Many potential lung transplants are lost because of hypoxemia during donor management
Our study showed that the apnea test was associated with a marked decrease in arterial oxygen tension (PaO2)/fractional inspired oxygen (FiO2) ratio, which could be restored by an recruitment maneuver (RM) performed immediately after the reconnection to the ventilator
Our study showed that the apnea test was associated with impairment in respiratory function in potential organ donors, and this may limit the eligibility for donor lung harvest
Summary
Many potential lung transplants are lost because of hypoxemia during donor management. We hypothesized that the apnea test, necessary to confirm the diagnosis of brain death in potential lung donors, was involved in the decrease in the ratio of partial pressure of arterial O2 to fraction of inspired O2 (PaO2/FiO2) and that a single recruitment maneuver performed just after the apnea test can reverse this alteration. Arterial blood gas standard criteria for lung donors are a ratio of arterial oxygen tension (PaO2) to fractional inspired oxygen (FiO2) of greater than 300 mm Hg and a positive end-expiratory pressure (PEEP) of 5 cm H2O [3]. During the donor management and before organ procurement, many factors may damage the respiratory function of the donor One of these factors is the apnea test, used to assess the clinical diagnosis of. We hypothesized that the apnea test used to diagnose brain death could impair gas exchange in potential lung donors and that a single RM performed immediately after could restore it
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