Efficacy of recruitment maneuver for improving the brain dead marginal lungs to ideal

Transplant Proc. 2013;45(10):3531-3. doi: 10.1016/j.transproceed.2013.09.001.

Abstract

Background: Because of the shortage of lungs for transplantation, finding the suitable lungs in brain-dead donors is an important issue. Recruitment maneuver is a strategy aimed at re-expanding collapsed and edematous lung tissue. The aim of this study was to assess the efficacy of this maneuver on improving marginal lungs for transplantation.

Methods: From 127 brain-dead potential donor which were evaluated for lung donation in Masih Daneshvari Organ Procurement Unit of Tehran, Iran, 31 (25%) had marginal lungs for transplantation. These donors had normal chest X ray or bilateral infiltration and had PaO2 200-300 mm Hg with FIO2 100%. The recruitment maneuver was performed and arterial blood gas was obtained before and after maneuver. The maneuver lasts for 2 hours with continuous check of O2 saturation and patient's hemodynamic during. Finally, patients with normal bronchoscopy and PaO2/FIO2 >300 mm Hg were considered good candidates for lung transplantation. The frequency (%) and mean ± SD were used for description of variables and the Wilcoxon test was used for comparison between pre- and post-maneuver PaO2 with FIO2 100%.

Results: The mean ± SD of PaO2/FIO2 with 100% FIO2 of patients before and after recruitment were 239 ± 62 and 269 ± 91, respectively. Recruitment maneuver could convert 10 marginal lungs (32%) to appropriate ones (PaO2 > 300) and finally 8 lungs were transplanted.

Conclusions: Findings of this study showed that recruitment maneuver could convert inappropriate lungs to appropriate ones in one third of brain-dead patients who had marginal lung condition. So, it is recommended that this maneuver is considered in the assessment protocol of lungs for donation.

MeSH terms

  • Adolescent
  • Adult
  • Blood Gas Analysis
  • Brain Death / physiopathology*
  • Bronchoscopy
  • Female
  • Humans
  • Iran
  • Lung / physiopathology
  • Lung / surgery*
  • Lung Transplantation* / adverse effects
  • Male
  • Prospective Studies
  • Pulmonary Atelectasis / mortality
  • Pulmonary Atelectasis / physiopathology
  • Pulmonary Atelectasis / therapy*
  • Pulmonary Edema / mortality
  • Pulmonary Edema / physiopathology
  • Pulmonary Edema / therapy*
  • Respiration, Artificial / methods*
  • Tissue Donors / supply & distribution*
  • Treatment Outcome
  • Young Adult