Intrapulmonary Percussive Ventilation as a Lung Recruitment Strategy in Brain-Dead Organ Donors

Abstract

Objective: To determine the strength of the evidence evaluating the effectiveness of intrapulmonary percussive ventilation (IPV) as a safe alternative or adjunctive therapy to traditional chest physiotherapy (CPT) among potential organ donors. Data Sources: Literature search conducted from February 2015 to November 2015 using PubMed, Cumulative Index of Nursing and Allied Health Literature, Scopus, and bibliographies of pertinent articles. Search Terms: Intrapulmonary percussive ventilation, chest physiotherapy, chest wall oscillation, organ donors, and ventilation. Study Selection: Articles in English from 1994 to present directly compared IPV to CPT or conventional (no) therapy. Data Extraction: Association of Critical-Care Nurses Levels of Evidence was used to determine the strength of evidence. Level B and level C articles were reviewed. Data Synthesis: No studies were found using IPV in the donor population. Results from studies using IPV in other populations indicated IPV had no adverse effects, improved sputum clearance and oxygenation, and reduced atelectasis and pneumonia in patients with artificial airways. Conclusion: Intrapulmonary percussive ventilation may be a safe and effective alternative or adjunctive to CPT therapy and improve the number of lungs available for transplantation. Clinical research is essential to determine the effectiveness of this therapy for lung recruitment in the donor population.

Variations in the Efficiency of Albuterol Delivery and Intrapulmonary Effects With Differential Parameter Settings on Intrapulmonary Percussive Ventilation

“…Recently, the IPV treatment has also been performed to improve the viability and availability of lungs of brain-dead organ donors for lung transplantation. 28,29 A study by Deakins and Chatburn 14 used IPV settings at frequencies that ranged from 180 to 220 cycles/min and operational pressure equal to 15-30 cm H 2 O of the peak pressure for albuterol delivery in pediatric subjects with atelectasis. Results of our study suggested decreasing frequency to ϳ100 cycles/min and increasing operational pressure to improve drug delivery, irrespective of C L .…”

Successful lung transplantation after prone positioning in an ineligible donor: a case report

“…The lungs of BD donors are easily obstructed due to excessive secretions, atelectasis, infection, inflammation, and gravitational forces, which result in a ventilation-perfusion mismatch and dead space ventilation [ 10 ]. For marginal or unsuitable donors, aggressive lung management protocols can improve oxygenation and allow lung transplantation [ 11 ]. In this case, the donor’s hypoxemia was not corrected by the conventional recruitment maneuver.…”

Respiratory physiotherapy as a tool to allow and optimize lung donation

“…The bibliography review about respiratory physiotherapy and organ donation just produced a couple of matches: Raios et al (2017) documented the use and percentage of chest physiotherapy techniques in potential lung donors at an Australian tertiary hospital. Another study by Lerg et al (2017) focused on the safety of intrapulmonary percussive ventilation in potential lung donors [ [4] , [5] , [6] ].…”