Improvement in the ratio of PaO2 to the fraction of inspired oxygen and treatment of pulmonary infections in donors have been cited as important goals for improving lungs before implantation and restoring marginal lungs to the donor pool. Likewise, improving donor PaO2 is often critical for other organs during donor care. The common physiological mechanisms responsible for hypoxemia are ventilation/perfusion mismatching, abnormal oxygen diffusion, and hypoventilation. These mechanisms are discussed and treatment options are considered.
Get full access to this article
View all access options for this article.
References
1.
OrensJBBoehlerAde PerrotM. A review of lung transplant donor acceptability criteria. J Heart Lung Transplant.2003;22:1183–1200.
2.
HenigNRPiersonDJ. Mechanisms of hypoxemia. Respir Care Clin North Am.2000;6:501–521.
3.
WestJB. Regional differences in the lung. Chest.1978;74:426–436.
4.
DantzkerDR. The ventilation-perfusion relationship in the lung. Perspect Crit Care.1989;2:87–101.
5.
KruseJA. Blood gas and oximetry monitoring. In: KruseJAFinkMPCarlsonRW, eds. Saunders Manual of Critical Care.Philadelphia, Pa: WB Saunders Co; 2003:788–792.
6.
PownerDJDarbyJMStuartSA. Recommendations for mechanical ventilation during donor care. Prog Transplant.2000;10:33–38.
7.
WannerASalathéMO'RiordanTG. Mucociliary clearance in the airways. Am J Respir Crit Care Med.1996;154:1868–1902.
8.
CliftonEEGrossiCEEsakofER. Management of pulmonary complications of surgical operations (primarily atelectasis) with pancreatic dornase inhalations. Surgery.1961;50:176–185.
9.
FolletteDMRudichSMBabcockWD. Improved oxygenation and increased lung donor recovery with high-dose steroid administration after brain death. J Heart Lung Transplant.1998;17:423–429.
10.
NataleJEPfeifleJHomnickDN. Comparison of intrapulmonary percussive ventilation and chest physiotherapy: A pilot study in patients with cystic fibrosis. Chest.1994;105:1789–1793.
11.
KreiderMELipsonDA. Bronchoscopy for atelectasis in the ICU: A case report and review of the literature. Chest.2003;124:344–350.
12.
KirilloffLHOwensGRRogersRMMazzoccoMC. Does chest physical therapy work?Chest.1985;88:436–444.
13.
StillerK. Physiotherapy in intensive care: Towards an evidence-based practice. Chest.2000;118:1801–1813.
14.
BravermanJM. Increasing the quantity of lungs for transplantation using high-frequency chest wall oscillation: A proposal. Prog Transplant.2002;12:266–274.
15.
BabcockWDMenzaRLRiznykS. Results of a prospective study using high-frequency chest wall oscillation of organ donors [abstract]. J Heart Lung Transplant.2002;21:141.
16.
StillerKGeakeTTaylorJGrantRHallB. Acute lobar atelectasis: A comparison of two chest physiotherapy regimens. Chest.1990;98:1336–1340.
17.
ScholtenDJNovakRSnyderJV. Directed manual recruitment of collapsed lung in intubated and nonintubated patients. Am Surg.1985;51:330–335.
18.
ParatzJLipmanJMcAuliffeM. Effect of manual hyperinflation on hemodynamics, gas exchange, and respiratory mechanics in ventilated patients. J Intensive Care Med.2002;17:317–324.
19.
BrowerRGRubenfeldGD. Lung-protective ventilation strategies in acute lung injury. Crit Care Med.2003;31 (suppl):S312–S316.
20.
GattinoniLVagginelliFChiumelloDTacconePCarlessoE. Physiologic rationale for ventilator setting in acute lung injury/acute respiratory distress syndrome patients. Crit Care Med.2003;31(suppl):S300–S304.
21.
ARDS Clinical Trials Network, National Heart, Lung, and Blood Institute, National Institutes of Health. Effects of recruitment maneuvers in patients with acute lung injury and acute respiratory distress syndrome ventilated with high positive end-expiratory pressure. Crit Care Med.2003;31:2592–2597.
22.
MedoffBDHarrisRSKesselmanHVenegasJAmatoMBPHessD. Use of recruitment maneuvers and high positive end-expiratory pressure in a patient with acute respiratory distress syndrome. Crit Care Med.2000;28:1210–1216.
23.
KavanaghBP. Lung recruitment in real time: Learning was never so easy. Am J Respir Crit Care Med.2003;167:1585–1586.
24.
MaggioreSMBrochardL. Pressure-volume curve: Methods and meaning. Minerva Anestesiol.2001;67:228–237.
25.
DriesDJMariniJJ. Optimized positive end-expiratory pressure: An elusive target. Crit Care Med.2002;30:1159–1160.
26.
AgustíAGNCardúsJRocaJGrauJMXaubetARodriguez-RoisinR. Ventilation-perfusion mismatch in patients with pleural effusion: Effects of thoracentesis. Am J Respir Crit Care Med.1997;156:1205–1209.
27.
DobynsEL. Pleural effusions and hypoxemia [editorial]. Crit Care Med.1999;27:472.
28.
DiaconAHBrutscheMHSolèrM. Accuracy of pleural puncture sites: A prospective comparison of clinical examination with ultrasound. Chest.2003;123:436–441.
29.
TalmorMHydoLGershenwaldJGBariePS. Beneficial effects of chest tube drainage of pleural effusion in acute respiratory failure refractory to positive end-expiratory pressure ventilation. Surgery.1998;123:137–143.
30.
KlingerJR. Inhaled nitric oxide in ARDS. Crit Care Clin.2002;18:45–68.
31.
WardNS. Effects of prone position ventilation in ARDS: An evidence-based review of the literature. Crit Care Clin.2002;18:35–44.
WestJB. Pulmonary Pathophysiology: The Essentials.6th ed.Philadelphia, Pa: Lippincott; 2003.
34.
PennefatherSHBullockREDarkJH. The effect of fluid therapy on alveolar arterial oxygen gradient in brain-dead organ donors. Transplantation.1993;56:1418–1422.
35.
MatalonSLazrakAJainLEatonDC. Lung edema clearance: 20 years of progress. J Appl Physiol.2002;93:1852–1859.
36.
MartinGSMangialardiRJWheelerAPDupontWDMorrisJABernardGR. Albumin and furosemide therapy in hypoproteinemic patients with acute lung injury. Crit Care Med.2002;30:2175–2182.
37.
MartinGS. Fluid balance and colloid osmotic pressure in acute respiratory failure: Emerging clinical science. Crit Care.2000;4(suppl):S21–S25.
38.
LewisCAMartinGS. Understanding and managing fluid balance in patients with acute lung injury. Curr Opin Crit Care.2004;10:13–17.
39.
GroeneveldABJ. Albumin and artificial colloids in fluid management: Where does the clinical evidence of their utility stand?Crit Care.2000;4:S16–S20.
40.
AllisonSPLoboDN. Debate: Albumin administration should not be avoided. Crit Care.2000;4:147–150.
41.
PulimoodTBParkGR. Debate: Albumin administration should be avoided in the critically ill. Crit Care.2000;4:151–155.
