The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

IMPACT OF A UNIFORM VENTILATOR PROTOCOL UTILIZING A MODIFIED OPEN LUNG CONCEPT AND OTHER LUNG PROTECTIVE STRATEGIES ON POTENTIAL LUNG DONORS

Sharon L. McRee1, C. Michael Buechler2, Aben�mar Arrillaga2



Background: At Mission Health System the number of lungs physiologically suitable for organ donation has been far below that of other perfused organs. This mirrors the rest of the nation. In 2007 an aggressive approach to ventilating potential lung donors was trialed in Neuro-Trauma ICU. It was hypothesized that ventilating donors with a modified open lung technique utilized in the Trauma Ventilator Management Protocol and consistent critical care management may result in an increased number of lungs available for transplantation. In 2007 Trauma Surgery assumed critical care management of all organ donors. After declaration of brain death all potential lung donors were placed on a pressure mode, Bi-Level or PCV, PEEP 10-18cm/H2O, I:E 1:1 and Vt 6-8 cc/kg IBW.

Methods: A retrospective, observational, cohort study of all consented organ donors in 2006 and 2007 was conducted. Data was collected from the time brain death was declared to the last recorded parameter. The MAP, Mode, I:E Ratio and PEEP were collected and means were calculated. A P/F ratio was calculated from data collected from ABGs. All statistical analysis was completed with Minitab 14 statistical software. Analysis of Variance (ANOVA), along with main effects and interaction plots were used to identify significant factors. Baseline data was compared to post process change data to identify a statistically significant change. A comparison of proportions was used in that analysis. All data analysis was completed assuming a 95% Confidence Interval (CI). A p-value < 0.05 was considered statistically significant in proportional comparisons.

Results: In 2007 the mean I:E (p-value of 0.000), MAP (p-value 0.002), PEEP (p-value of 0.001) and P/F ratio (p-value 0.009) all increased. This resulted in a significant increase in lungs placed in 2007 (p-value 0.000). In 2006 from 13 potential lung donors 2 were taken to OR for recovery, a 15% success rate. In 2007 from 16 potential lung donors 12 were taken to OR for recovery, a 75% success rate. An incidental finding was the number of organs per donor increased from 2.81 in 2006 to 3.78 in 2007.

Conclusion: By adopting an open lung technique of ventilating potential lung donors using lung protective strategies that keep the alveoli open and prevents volutrauma along with consistent critical care management, it appears possible to significantly impact the number of physiologically acceptable lungs available for transplantation