Airway Pressure Release Ventilation and Successful Lung Donation

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.