RT Journal
A1 Hanna K, Seder CW, Weinberger JB, Sills PA, Hagan M, Janczyk RJ
T1 AIrway pressure release ventilation and successful lung donation
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD March 1
VO 146
IS 3
SP 325
OP 328
DO 10.1001/archsurg.2011.35
UL http://dx.doi.org/10.1001/archsurg.2011.35
AB Hypothesis 
    Donor management with airway pressure release ventilation (APRV) improves oxygenation and increases lung donation while maintaining equivalent graft survival.Design 
    Retrospective case series.Setting 
    Private, tertiary care, level I trauma center.Patients 
    Forty-five consecutive organ donors.Interventions 
    Management with assist/control ventilation (ACV) or APRV.Main Outcome Measures 
    Demographic characteristics, medical history, mode of brain death, and partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FIO2) ratios on admission and after 100% oxygen challenge, percentage of lungs transplanted, and graft survival.Results 
    Twenty potential donors were managed with ACV and 25 were managed with APRV during the study period. The APRV patients were younger than the ACV patients (mean [SD] age, 34 [11] vs 41 [12] years, respectively; P = .05). Otherwise, there was no difference between the ACV and APRV groups with respect to demographic characteristics, medical history, or mode of brain death. Although the ACV and APRV groups had similar PaO2/FIO2 ratios on admission and the mean time on the ventilator was the same, the APRV group had a higher PaO2/FIO2 ratio than the ACV group (mean [SD], 498 [43] vs 334 [104] mm Hg, respectively; P < .001) after 100% oxygen challenge. The ACV group ultimately donated 7 of 40 potential lungs (18%) compared with 42 of 50 potential lungs (84%) in the APRV group (P < .001). There was no difference in the number of other organs per donor procured from the 2 groups. Survival of grafts managed with both APRV and ACV compared favorably with national averages.Conclusion 
    The use of APRV prior to procurement may increase the rate of successful lung donation.