Ventilation Changes Could Double Number of Lungs Available for Transplant

Michael's Hospital (Toronto, Canada), the University of Turin (Italy), and other institutions conducted a randomized controlled trial of 118 patients with beating hearts who were potential organ donors at 12 European intensive care units (ICUs) between September 2004 to May 2009. The potential donors were randomized to conventional ventilatory strategy--tidal volumes of 10 mL/kg - 12 mL/kg of predicted body weight, positive end-expiratory pressure (PEEP) of 3 cm - 5 cm H2O, apnea tests performed by disconnecting the ventilator, and open circuit for airway suction--or to the protective ventilatory strategy--tidal volumes of 6 mL/kg - 8 mL/kg of predicted body weight, PEEP of 8 cm - 10 cm H2O, apnea tests performed by using continuous positive airway pressure (CPAP), and closed circuit for airway suction. The main outcome measures were the number of organ donors meeting eligibility criteria for harvesting, number of lungs harvested, and 6-month survival of lung transplant recipients.

The results showed that the number of patients who met lung donor eligibility criteria after the 6-hour observation period was 32 (54%) in the conventional strategy group compared to 56 (95%) in the protective strategy group. The number of patients in whom lungs were harvested was 16 (27%) in the conventional strategy group compared to 32 (54%) in the protective strategy group. Six-month survival rates did not differ between recipients who received lungs from donors ventilated with the conventional strategy compared with the protective strategy. The study was published in the December 15, 2010, issue of the Journal of the American Medical Association (JAMA).

"A lot of patients who are waiting for lung transplants die before they get a transplant because there aren't enough organs,” said study coauthor Arthur Slutsky, MD, vice president of research at St. Michael's Hospital. "By using this lung protective strategy, one can essentially double the number of lungs available for transplant.”

The lung protective strategy involves using smaller tidal volumes, thus pumping in less air into the lungs with each breath, to prevent injury to the lungs. It also used higher PEEP (the amount of pressure applied by the ventilator at the end of an exhalation), so as to prevent the lungs from collapsing.

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