Effect of a Lung Protective Strategy for Organ Donors on Eligibility and Availability of Lungs for Transplantation

Mascia, Luciana; Pasero, Daniela; Slutsky, Arthur S.; Arguís, M.J.; Berardino, Maurizio; Grasso, Salvatore; Munari, Marina; Boifava, Silvia; Cornara, G.; Corte, Francesco Della; Vivaldi, Nicoletta; Malacarne, P; Gaudio, Paolo Del; Livigni, Sergio; Zavala, Edward Y.; Filippini, Claudia; Martin, Erica L.; Donadio, P.P.; Mastromauro, Ilaria; Ranieri, V. Marco

doi:10.1001/jama.2010.1796

Cited by 320 publications

(178 citation statements)

References 31 publications

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“…5 Anesthesiologists frequently provide intraoperative management of organ donor patients, and the appropriate management of these patients is essential for maximizing the quality and success of the organs procured. 6 Nevertheless, scant literature exists specifically to guide anesthesiologists in the intraoperative management of the organ donor.…”

Section: Résumémentioning

confidence: 99%

“…Resultant respiratory distress can progress to apnea and cardiac arrest. 19 A lung-protective ventilatory strategy should be employed, with tidal volumes of 6-8 mLÁkg -1 and a positive end-expiratory pressure (PEEP) of 8-10 cm H 2 O, 6 especially if lung procurement is planned. Evidence is lacking to support the maintenance of respiratory alkalosis during organ procurement.…”

Section: Pulmonarymentioning

confidence: 99%

“…44,74 Once mechanical ventilation is re-initiated, tidal volumes should be 6-8 mgÁkg -1 with 8-10 cm H 2 O PEEP in order to decrease the risk of acute lung injury. 6 Liver transplantation Although favourable outcomes have been achieved with the use of DCD liver grafts, 75 there has been a higher rate of biliary complications associated with these organs, and thus, they are considered to represent a higher risk option for the recipient. Factors such as patient weight, total ischemia time, and donor age can affect recipient outcome.…”

Section: Lung Transplantationmentioning

confidence: 99%

See 2 more Smart Citations

Anesthetic considerations in organ procurement surgery: a narrative review

Anderson

Bekker

Vagefi

2015

Can J Anesth/J Can Anesth

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Section: Résumémentioning

confidence: 99%

Section: Pulmonarymentioning

confidence: 99%

Section: Lung Transplantationmentioning

confidence: 99%

See 1 more Smart Citation

Anesthetic considerations in organ procurement surgery: a narrative review

Anderson

Bekker

Vagefi

2015

Can J Anesth/J Can Anesth

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“…Recientemente, un estudio randomizado multicéntrico que incluyó 400 pacientes sometidos a cirugía abdominal mayor, demostró que una estrategia ventilatoria protectora consistente en limitación del Vt a 8 ml/kg y uso de PEEP, fue capaz de reducir la incidencia de complicaciones posoperatorias pulmonares y extrapulmonares a la tercera parte 52 . Finalmente, en un estudio multicéntrico randomizado en 118 pacientes con muerte encefálica, la aplicación de una estrategia ventilatoria protectora (Vt 6-8 ml/kg IBW, PEEP 8-10 cmH 2 O), vs una convencional (Vt 10-12 ml/kg IBW, PEEP 3-5 cm H 2 O), aumentó el número de pacientes que cumplió criterios para donación de pulmón de 54% a 95% (p = 0,001) 53 . Entre los criterios de elegibilidad para donación de pulmón se cuenta una PaO 2 /FiO 2 > 300 con O 2 100% y 5 cmH 2 O PEEP, una radiografía de tórax normal, y una presión máxima de vía aérea menor a 30 cmH 2 O.…”

Section: Manejo Ventilatorio Del Potencial Donante Cadáverunclassified

Manejo del potencial donante cadáver

et al. 2014

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“…However, recent research suggests that lung protective ventilatory strategies may be safe and effective in managing concurrent ALI/ARDS and severe brain injury [3,13,14]. In an intriguing recent report on organ donors who had suffered catastrophic brain injury, the use of a lung protective strategy was associated with a higher proportion of eligible and harvested lungs compared with a conventional strategy [15]. Taken together, these results suggest there is sufficient equipoise to undertake a randomized clinical trial of lung protective ventilation in patients with severe brain injury provided that PaCO 2 is maintained within a normal range.…”

mentioning

confidence: 99%

The brain–lung–brain axis

Stevens

Puybasset

2011

Intensive Care Med

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Severe neurological dysfunction and injury are associated with a propensity to develop concurrent pulmonary edema and lung injury which can further worsen clinical outcomes [1]. This has been observed in a range of settings including traumatic brain injury [2], aneurysmal subarachnoid hemorrhage [3], status epilepticus [4], and in brain death [5]. More recently, studies have shown that critical pulmonary disorders such as acute lung injury and acute respiratory distress syndrome (ALI/ARDS) may be responsible for brain injury and poor neurocognitive outcomes [6, 7]. While the implications of these findings are considerable, the underlying biological mechanisms need clarification.In this issue of Intensive Care Medicine, Heuer et al.[8] use a porcine model to evaluate the independent and combined effects of sustained acute intracranial hypertension (AICH) and experimental ARDS on measures of lung injury and brain damage. They noted that markers of lung injury were augmented with AICH and further rose with concurrent AICH/ARDS. Moreover, measures of cerebral damage were increased in ARDS and even more elevated in combined AICH/ARDS. The study is remarkable if only because of its comprehensive design and the generous array of methods used to assess organ function and tissue injury including physiological measures (intracranial pressure, brain tissue pO 2 , heart rate variability, transpulmonary thermodilution), radiological assessments (quantitative brain and lung CT), biological markers (neuron-specific enolase, S100beta, cytokines), and histopathological analysis of lung and brain tissue. To our knowledge, it is one of the first studies to systematically address and quantify the independent and additive effects of neurological and lung injury. Limitations of this work must also be acknowledged. The balloon/AICH model is physiologically remote from traumatic brain injury in which the preponderance of damage is diffuse, not focal, and in which ICP elevations are generally paroxysmal in nature, not constant. Second, the animals were killed after only 4 h, resulting in a loss of valuable information on the natural history of AICH and/or ALI/ARDS in this model. Third, while increased edema was observed in both brain and lung, the available data do not address the underlying physiologic mechanism: was the pulmonary edema hydrostatic or due to increased capillary permeability? Was the brain edema vasogenic or cytotoxic in nature? It has been suggested that pulmonary edema following brain injury is in large part mediated via unbalanced catecholamine release resulting in pulmonary venous constriction and/or left ventricular failure [9, 10]; however, Heuer et al. do not clarify these aspects.It is becoming increasingly apparent that lung and brain represent an integrated physiological ensemble such that insults involving one will compromise the other and

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Effect of a Lung Protective Strategy for Organ Donors on Eligibility and Availability of Lungs for Transplantation

Cited by 320 publications

References 31 publications

Anesthetic considerations in organ procurement surgery: a narrative review

Anesthetic considerations in organ procurement surgery: a narrative review

Manejo del potencial donante cadáver

The brain–lung–brain axis

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