Lung Focused Resuscitation at a Specialized Donor Care Facility Improves Lung Procurement Rates

Chang, Stephanie H.; Kreisel, Daniel; Marklin, Gary; Cook, Lindsey R.; Hachem, Ramsey R.; Kozower, Benjamin D.; Balsara, Keki R.; Bell, Jennifer M.; Frederiksen, Christine; Meyers, Bryan F.; Patterson, G. Alexander; Puri, Varun

doi:10.1016/j.athoracsur.2017.12.009

Cited by 54 publications

(46 citation statements)

References 9 publications

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“…The fear of developing pulmonary edema with aggressive fluid replacement was not realized in our study, and the lung O:E actually increased from 1.18 to 1.30. We have previously published our donor lung management protocol and consistently exceed the national average for lungs transplanted per donor which explains the baseline O:E > 1 . Optimizing SV with volume resuscitation did not cause a loss of transplantable lungs.…”

Section: Discussionmentioning

confidence: 80%

A stroke volume‐based fluid resuscitation protocol decreases vasopressor support and may increase organ yield in brain‐dead donors

Marklin¹,

Klinkenberg²,

Helmers³

et al. 2020

Clinical Transplantation

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Brain‐dead donors are frequently hypovolemic and hypotensive requiring vasopressor support. We studied a stroke volume‐based fluid resuscitation and vasopressor weaning protocol prospectively on 64 hypotensive donors, with a recent control cohort of 30 hypotensive donors treated without a protocol. Stroke volume was measured every 30 minutes for 4 hours by pulse contour analysis or esophageal Doppler. A 500 mL saline fluid bolus was infused over 30 minutes and repeated if the stroke volume increased by 10%. No fluid was infused if the stroke volume did not increase by 10%. Vasopressors were weaned every 10 minutes if the mean arterial pressure was greater than 65 mm Hg. The protocol group received 1937 ± 906 mL fluid compared to 1323 ± 919 mL in the control group (P = .003). Mean time on vasopressors was decreased from 957.6 ± 586.2 to 176.3 ± 82.2 minutes (P<.001). Donors in the protocol group were more likely to donate four or more organs than donors in the control group (OR = 4.114, 95% Confidence Interval (CI) = 1.003‐16.876). While more organs were transplanted per donor in the protocol group (3.39 ± 1.52) than in the control group (2.93 ± 1.44) (P = .268), the difference did not reach statistical significance. A goal‐directed fluid resuscitation protocol decreased organ ischemia and may increase organs transplanted.

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Section: Discussionmentioning

confidence: 80%

A stroke volume‐based fluid resuscitation protocol decreases vasopressor support and may increase organ yield in brain‐dead donors

Marklin¹,

Klinkenberg²,

Helmers³

et al. 2020

Clinical Transplantation

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“…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 .…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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BACKGROUND: Intrapulmonary percussive ventilation (IPV) is used for airway clearance and delivery of aerosol medications, including bronchodilators. Despite the common use of IPV for drug delivery, few data are available regarding optimization of inhalation therapy with IPV. In this study, we investigated the influence of IPV setting parameters and lung mechanics on drug delivery via IPV alone. METHODS: An IPV device was connected to a lung model via a trachea model and a flow analyzer. Albuterol nebulized from the IPV device was collected onto a filter attached between the trachea and lung models, and was quantitated by spectrophotometry (230 nm). RESULTS: Albuterol delivery to the lung model was increased up to 2.1-fold, with decreasing percussion frequency. Decreasing percussion frequency concomitantly increased the tidal volume, and albuterol delivery was correlated with tidal volume (r ‫؍‬ 0.91, P < .001). Airway resistance had a negative impact on albuterol delivery, whereas lung compliance had no significant effect. Increasing operational pressure increased albuterol delivery while increasing peak inspiratory pressure. CONCLUSIONS: Albuterol delivery and tidal volume with IPV can be improved by maintaining low levels of percussion frequency and increasing operational pressure. When increasing operational pressure, the peak inspiratory pressure and airway resistance levels need to be carefully monitored for safe inhalation therapy with IPV.

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“…In 2001, MTS established a specialized donor care facility, with the goal of simplifying donor care and optimizing organ yield. This unique model has led to organ recovery rates comparable to or better than conventional, hospital‐based donor management while also leading to cost savings for the system . Since then, at least 12 other OPOs have adopted or are in the process of adopting this model of care.…”

Section: Comparison Of Clinical Characteristics and Organ Costs For Lmentioning

confidence: 99%

Unintended consequences of changes to lung allocation policy

Puri

Hachem

Frye

et al. 2019

American Journal of Transplantation

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Organ allocation for transplantation aims to balance the principles of justice and medical utility to optimally utilize a scarce resource. To address practical considerations, the United States is divided into 58 donor service areas (DSA), each constituting the first unit of allocation. In November 2017, in response to a lawsuit in New York, an emergency action change to lung allocation policy replaced the DSA level of allocation for donor lungs with a 250 nautical mile circle around the donor hospital. Similar policy changes are being implemented for other organs including heart and liver. Findings from a recent US Department of Health and Human Services report, supplemented with data from our institution, suggest that the emergency policy has not resulted in a change in the type of patients undergoing lung transplantation (LT) or early postoperative outcomes. However, there has been a significant decline in local LT, where donor and recipient are in the same DSA. With procurement teams having to travel greater distances, organ ischemic time has increased and median organ cost has more than doubled. We propose potential solutions for consideration at this critical juncture in the field of transplantation. Policymakers should choose equitable and sustainable access for this lifesaving discipline.

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Lung Focused Resuscitation at a Specialized Donor Care Facility Improves Lung Procurement Rates

Cited by 54 publications

References 9 publications

A stroke volume‐based fluid resuscitation protocol decreases vasopressor support and may increase organ yield in brain‐dead donors

A stroke volume‐based fluid resuscitation protocol decreases vasopressor support and may increase organ yield in brain‐dead donors

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

Unintended consequences of changes to lung allocation policy

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