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

Abstract

The current investigators applied nonlinear mathematical tools to HR and RR time series during weaning trials and compared these analyses between successfully weaned patients and those who failed weaning. They found that patients who had successful weaning had a more complex pattern of HR and RR patterns than those who failed. They proposed a model to predict weaning that was more accurate for their group of patients than the conventional model that included rapid shallow breathing index and airway occlusion pressure at 0.1 second.Although the results are very interesting, they cannot be endorsed for 2 main reasons. First, they are very complex to perform and are not fully understood by physicians. In addition, the current results can only serve as a hypothesis for future studies. Despite these reservations, it is important to realize that the future of complex signal analysis is drawing near and that we, the clinical community, have to start to embrace this complex mathematical field if we wish to understand the information we derive from our physiologic monitoring devices.

Hydrogen inhalation decreases lung graft injury in brain-dead donor rats

“…[43][44][45] In this study, the FIO 2 of 0.5 was chosen to maximize the quantity and improve the quality of the donor. In preliminary experiments, a PEEP of 5 cm H 2 O affected hemodynamic stability, so a PEEP at 2 cm H 2 O was chosen.…”

Lung donor treatment protocol in brain dead-donors: A multicenter study

“…11 Mascia et al demonstrated that a protective lung strategy in patients diagnosed with brain death could hinder the development of lung dysfunction and double the number of lungs available for transplantation. 16 These investigators observed that protective ventilator management alone doubled the rate of lung grafts available for transplant, mainly because PaO 2 /FIO 2 remained the same in the protective group and decreased in the conventional group. The fall in PaO 2 /FIO 2 levels from brain death to organ recovery is one of the main reasons for Evolution of PaO 2 /FIO 2 (relation between arterial oxygen pressure and inspiration oxygen fraction [mm Hg]) in potential lung donors after treatment implementation.…”

“…Improvements in lung procurement with donor-management strategies have also been reported by others. 7,16 However, most of these studies have included very strict exclusion criteria that ruled out many potential donors 16 or a young average lung donor age, even o40 years of age. 7 We applied this treatment to all donors with no absolute contraindications for lung donation, which brought our lung donor age close to 50 years (see Table 3).…”

Organprotektive Intensivtherapie und Simulatortraining

“…Vergleichbar häufig werden nach Organentnahme die Lungenexplantate zur Transplantation abgelehnt. Schätzungen gehen davon aus, dass deutlich mehr Lungen transplantabel wären [1,42] [1,7,25,43].…”