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A Recruitment Maneuver After Apnea Testing Improves Oxygenation and Reduces Atelectasis in Organ Donors After Brain Death
Journal article   Peer reviewed

A Recruitment Maneuver After Apnea Testing Improves Oxygenation and Reduces Atelectasis in Organ Donors After Brain Death

Rajat Dhar, Porche Braun, Atul Kumar, Jayesh Patel, Flavia L Lee and Baback Arshi
Neurocritical care, v 41(2), pp 576-582
Oct 2024
DOI: https://doi.org/10.1007/s12028-024-01975-7
PMID: 38580801
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Adult Aged Apnea Brain Death - diagnosis Female Humans Male Middle Aged Oxygen - metabolism Positive-Pressure Respiration - methods Pulmonary Atelectasis - diagnostic imaging Pulmonary Atelectasis - etiology Pulmonary Atelectasis - prevention & control Tissue Donors Hypoxia
Hypoxemia is the main modifiable factor preventing lungs from being transplanted from organ donors after brain death. One major contributor to impaired oxygenation in patients with brain injury is atelectasis. Apnea testing, an integral component of brain death declaration, promotes atelectasis and can worsen hypoxemia. In this study, we tested whether performing a recruitment maneuver (RM) after apnea testing could mitigate hypoxemia and atelectasis. During the study period, an RM (positive end-expiratory pressure of 15 cm H O for 15 s then 30 cm H O for 30 s) was performed immediately after apnea testing. We measured partial pressure of oxygen, arterial (PaO ) before and after RM. The primary outcomes were oxygenation (PaO to fraction of inspired oxygen [FiO ] ratio) and the severity of radiographic atelectasis (proportion of lung without aeration on computed tomography scans after brain death, quantified using an image analysis algorithm) in those who became organ donors. Outcomes in RM patients were compared with control patients undergoing apnea testing without RM in the previous 2 years. Recruitment maneuver was performed in 54 patients after apnea testing, with a median immediate increase in PaO of 63 mm Hg (interquartile range 0-109, p = 0.07). Eighteen RM cases resulted in hypotension, but none were life-threatening. Of this cohort, 37 patients became organ donors, compared with 37 donors who had apnea testing without RM. The PaO :FiO ratio was higher in the RM group (355 ± 129 vs. 288 ± 127, p = 0.03), and fewer had hypoxemia (PaO :FiO ratio < 300 mm Hg, 22% vs. 57%; p = 0.04) at the start of donor management. The RM group showed less radiographic atelectasis (median 6% vs. 13%, p = 0.045). Although there was no difference in lungs transplanted (35% vs. 24%, p = 0.44), both better oxygenation and less atelectasis were associated with a higher likelihood of lungs being transplanted. Recruitment maneuver after apnea testing reduces hypoxemia and atelectasis in organ donors after brain death. This effect may translate into more lungs being transplanted.

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UN Sustainable Development Goals (SDGs)

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Collaboration types
Domestic collaboration
Web of Science research areas
Clinical Neurology
Critical Care Medicine
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