Lung Donor Selection and Management

Raemdonck, Dirk Van; Neyrinck, Arne; Verleden, Geert M.; Dupont, Lieven; Coosemans, Willy; Decaluwé, Herbert; Decker, G. Anton; Leyn, Paul De; Nafteux, Philippe; Lerut, Toni

doi:10.1513/pats.200808-098go

Cited by 204 publications

(163 citation statements)

References 110 publications

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“…If these conditions are not corrected, there is up to a 30% reduction in the likelihood of the feasibility of transplanting these lungs (D). (57) The objectives of bronchoscopy in a donor are as follows: to assess the bronchial anatomy; to evaluate and remove endobronchial foreign bodies; to identify and assess aspirated material for possible infection; and to clear secretions (D. (6,57,58) The performance of an early bronchoscopy is an important factor in the aggressive management of potential donors. 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).…”

Section: Lung Maintenancementioning

confidence: 99%

“…(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). (28,57) In donors presenting with evidence of gas exchange abnormalities and radiographic evidence of unilateral lung injury, a therapeutic bronchoscopy may support a contralateral lung assessment with the aim of avoiding the discarding of a potential donor organ and of contributing to graft survival (D). (6,29,57,63) Recommendations -A bronchoscopy is indicated for all potential lung donors (D) (29) (C).…”

Section: Lung Maintenancementioning

confidence: 99%

“…(28,57) In donors presenting with evidence of gas exchange abnormalities and radiographic evidence of unilateral lung injury, a therapeutic bronchoscopy may support a contralateral lung assessment with the aim of avoiding the discarding of a potential donor organ and of contributing to graft survival (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.…”

Section: Lung Maintenancementioning

confidence: 99%

“…(6,57) The recommended procedures are as follows: low-pressure tracheal suction (D), (28,57,58) chest percussion, postural drainage, decubitus positioning every 2 hours (D) (28) and pulmonary expansion techniques (D). (6,64) There are few studies concerning bronchial hygiene for deceased donors.…”

Section: Which Bronchial Hygiene Procedures Should Be Used?mentioning

confidence: 99%

“…Many of our recommendations are taken from the guidelines associated with other clinical conditions. Some studies (D) (57) have recommended that tracheal suction be performed with closed suction circuits. However, recent metaanalytical research involving living critical patients failed to show any significant difference regarding the incidence of mechanical ventilation-associated pneumonia when using closed suction circuits(A).…”

Section: Which Bronchial Hygiene Procedures Should Be Used?mentioning

confidence: 99%

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

Westphal¹,

Filho²,

Vieira³

et al. 2011

Rev. bras. ter. intensiva

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Brain death (BD) alters the pathophysiology of patients and may damage the kidneys, the lungs, the heart and the liver. To obtain better quality transplant organs, intensive care physicians in charge of the maintenance of deceased donors should attentively monitor these organs. Careful hemodynamic, ventilatory and bronchial clearance management minimizes the loss of kidneys and lungs. The evaluation of cardiac function and morphology supports the transplant viability assessment of the heart. The monitoring of liver function, the management of the patient's metabolic status and the evaluation of viral serology are fundamental for organ selection by the transplant teams and for the care of the transplant recipient. OBJECTIVEThese guidelines are aimed at contributing to the institutional coordination of organ transplantation and will provide "real world" guidelines that are appropriate in the Brazilian context for the uniform care of the deceased donor. Ultimately, this aim of this guide is to increase the quality and quantity of transplantable organs. METHODOLOGYThe Writing and Planning Committee, comprised of young intensive care physicians and intensive medicine residents, conducted an extensive literature review. From this review, they formulated questions and forwarded the questions to all of the authors of this article. These initial questions served as the starting point for receiving suggestions for the formulation of other questions and definitions.The final questions were revised by the Executive Committee and were returned to the authors to develop the guidelines presented in this article.The questions guided the literature review, which was conducted using the P.I.C.O. methodology where P stands for the target population, I for the intervention, C for the control or comparative group and O for the clinical outcome.The retrieved articles were critically analyzed and categorized according to their grade of recommendation and the strength of the presented evidence in the following manner:

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Section: Lung Maintenancementioning

confidence: 99%

Section: Lung Maintenancementioning

confidence: 99%

Section: Lung Maintenancementioning

confidence: 99%

Section: Which Bronchial Hygiene Procedures Should Be Used?mentioning

confidence: 99%

Section: Which Bronchial Hygiene Procedures Should Be Used?mentioning

confidence: 99%

See 3 more Smart Citations

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

Westphal¹,

Filho²,

Vieira³

et al. 2011

Rev. bras. ter. intensiva

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

Mascia

Pasero²,

Slutsky³

et al. 2010

JAMA

317

162

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mal pulmonary function at the time of brain death may have declines in functioning, and only 15% to 20% of these patients' lungs are subsequently suitable for transplantation. 1-3 This may result from the pulmonary damage associated with brain injury 4 or the iatrogenic effects of mechanical ventilation. 5,6 There is evidence in various settings demonstrating that a lung protective strategy is beneficial. In patients with acute lung injury, ventilation See also pp 2592 and 2643 and Patient Page.

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