Critical Care and Shock

The Use of APRV and Open Lung Management for Improving the Outcome of Lung Procurement for Transplantation

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One of the most difficult organs to procure for donation is the lung. A detailed understanding of the physiology of mechanical ventilation and its effect on donor lungs is needed to impact on the outcome of lung transplantation. An organized protocol for mechanical ventilation management of the organ donor using the Open Lung Model may positively affect the number of organs that can be procured, and the function of these organs post transplant.

Based on physiologic principles, the use of new modes of ventilation may affect the modulation of cytokines, decrease the transmigration of organisms into the donor lung, and preserve surfactant function in that lung. Therefore, we have developed a protocol guided by physiologic-based parameters and airway pressure release ventilation (APRV), with ongoing feedback from an advanced respiratory care team to manage donor patients closely.

Setting: 650 bed university hospital and transplant center.

Conclusion: We have developed a physiologic-based protocol, using APRV to achieve lung procurement that can decrease peak pressures and recruit the lungs using less and simultaneously increasing the PaO2 while using lower FIO2. This protocol may preserve surfactant function and assist during postoperative management. Additionally, this management mode may protect the donor organs from physiologic decay and even improve the outcomes. Further studies to measure long-term outcome need to be developed to validate physiologically based mechanical ventilation.