Fiberoptic bronchoscopy in brain-dead organ donors.

Abstract

Criteria for selecting lung donors include normal chest X-ray and adequate gas exchange, but normal bronchoscopy is not always required. Thus, we conducted a prospective study of fiberoptic bronchoscopy in 72 brain-dead donors scheduled for multiple organ procurement. Chest X-ray was considered normal in 37 donors (51%), and PaO2 was > 400 mm Hg with an FIO2 of 100% in 34 donors (47%). Fiberoptic bronchoscopy was normal in only 24 donors (33%). In the remaining 48 donors, inhalation of gastric contents (n = 26) or blood (n = 17), pulmonary contusion (n = 5), or purulent bronchial secretions (n = 4) were noted. In the 26 donors with normal chest X-ray and PaO2 > 400 mm Hg with FIO2 of 100%, bronchoscopy was abnormal in 10 donors (38%). In 33 donors, arteriovenous difference in oxygen content (2.4 +/- 0.8 ml O2/100 ml), and pulmonary shunt (0.30 +/- 0.11, range 0.13-0.49) were measured. In the 15 donors with PaO2 > 400 mm Hg, pulmonary shunt was 0.23 +/- 0.07 (range 0.13-0.35). Our study suggests that chest X-ray and arterial blood gas analysis are not sufficient, and that fiberoptic bronchoscopy should be routinely performed to select potential lung donors. Even in brain-dead donors, only the measurement of pulmonary shunt can precisely assess pulmonary gas exchange.

A Porcine Model of Acute Lung Injury by Instillation of Gastric Fluid

“…In a study by Riou et al, fiberoptic bronchoscopy in brain-dead organ donors revealed inhalation of gastric contents in 36% [20]. A disadvantage of the use of gastric juice is the difficulty to standardize the injury model.…”

Diretrizes para manutenção de múltiplos órgãos no potencial doador adulto falecido: Parte III. Recomendações órgãos específicas

“…Studies have shown that the performance of a bronchoscopy, along with frequent pulmonary suction (respiratory physical therapy) and pulmonary expansion ventilation techniques (using PEEP), results in a significant increase in both the quality of the donor organs and in the number of transplantable organs (D) (29) (C). (56,(59)(60)(61)(62) A bronchoscopy can be performed either by a local hospital physician or by the transplant team surgeon (D). (28) During the bronchoscopy, respiratory fluids should be collected (bronchoalveolar lavage fluid) for Gram staining and cultures with the aim of guiding eventual antibiotic therapy (D).…”

“…(6,29,57,63) Recommendations -A bronchoscopy is indicated for all potential lung donors (D) (29) (C). (56,(59)(60)(61)(62) Strong Recommendation. -If a bronchoscopy cannot be performed at the hospital of origin, clinicians should inform the team responsible for removing the organs that this test could not be performed.…”

Análise das características dos pulmões disponibilizados para transplante no Estado de São Paulo

“…Este teste é um pré-requisito de diversas equipes de transplante pulmonar para aceitação de um órgão, especialmente quando há evidências de aspiração de conteúdo gástrico ou de infecção, uma vez que, como já foi dito, a presença de secreções purulentas usualmente contra-indica a utilização do órgão. Sua importância foi demonstrada por inúmeros estudos, dentre eles o conduzido por Riou et al 34 em que constataram que somente 33% dos doadores com morte cerebral e apenas 62% de todos os doadores considerados ideais apresentavam broncoscopia macroscopicamente sem alterações.…”