title: Effect of a lung protective strategy for organ donors on eligibility and availability of lungs for transplantation: a randomized controlled trial.
abstract: BACKGROUND
  Many potential donor lungs deteriorate between the time of brain death and evaluation for transplantation suitability, possibly because of the ventilatory strategy used after brain death.
  
  
  OBJECTIVE
  To test whether a lung protective strategy increases the number of lungs available for transplantation.
  
  
  METHODS
  Multicenter randomized controlled trial of patients with beating hearts who were potential organ donors conducted at 12 European intensive care units from September 2004 to May 2009 in the Protective Ventilatory Strategy in Potential Lung Donors Study. Interventions Potential donors were randomized to the conventional ventilatory strategy (with tidal volumes of 10-12 mL/kg of predicted body weight, positive end-expiratory pressure [PEEP] of 3-5 cm H(2)O, apnea tests performed by disconnecting the ventilator, and open circuit for airway suction) or the protective ventilatory strategy (with tidal volumes of 6-8 mL/kg of predicted body weight, PEEP of 8-10 cm H(2)O, apnea tests performed by using continuous positive airway pressure, and closed circuit for airway suction).
  
  
  METHODS
  The number of organ donors meeting eligibility criteria for harvesting, number of lungs harvested, and 6-month survival of lung transplant recipients.
  
  
  RESULTS
  The trial was stopped after enrolling 118 patients (59 in the conventional ventilatory strategy and 59 in the protective ventilatory strategy) because of termination of funding. The number of patients who met lung donor eligibility criteria after the 6-hour observation period was 32 (54%) in the conventional strategy vs 56 (95%) in the protective strategy (difference of 41% [95% confidence interval {CI}, 26.5% to 54.8%]; P <.001). The number of patients in whom lungs were harvested was 16 (27%) in the conventional strategy vs 32 (54%) in the protective strategy (difference of 27% [95% CI, 10.0% to 44.5%]; P = .004). Six-month survival rates did not differ between recipients who received lungs from donors ventilated with the conventional strategy compared with the protective strategy (11/16 [69%] vs 24/32 [75%], respectively; difference of 6% [95% CI, -22% to 32%]).
  
  
  CONCLUSIONS
  Use of a lung protective strategy in potential organ donors with brain death increased the number of eligible and harvested lungs compared with a conventional strategy.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00260676.
authors.affiliation: Department of Anesthesia, University of Turin, San Giovanni Battista Molinette Hospital, Corso Dogliotti 14, Turin 10126, Italy.
authors.forename: Luciana
authors.initials: L
authors.lastname: Mascia
authors.forename: Daniela
authors.initials: D
authors.lastname: Pasero
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Slutsky
authors.forename: M Jose
authors.initials: MJ
authors.lastname: Arguis
authors.forename: Maurizio
authors.initials: M
authors.lastname: Berardino
authors.forename: Salvatore
authors.initials: S
authors.lastname: Grasso
authors.forename: Marina
authors.initials: M
authors.lastname: Munari
authors.forename: Silvia
authors.initials: S
authors.lastname: Boifava
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cornara
authors.forename: Francesco
authors.initials: F
authors.lastname: Della Corte
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Vivaldi
authors.forename: Paolo
authors.initials: P
authors.lastname: Malacarne
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Gaudio
authors.forename: Sergio
authors.initials: S
authors.lastname: Livigni
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Zavala
authors.forename: Claudia
authors.initials: C
authors.lastname: Filippini
authors.forename: Erica L
authors.initials: EL
authors.lastname: Martin
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Donadio
authors.forename: Ilaria
authors.initials: I
authors.lastname: Mastromauro
authors.forename: V Marco
authors.initials: VM
authors.lastname: Ranieri
mesh_terms: D000328:Adult; D001049:Apnea / Q000175:diagnosis; D046148:Donor Selection; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D016037:Single-Blind Method; D013396:Suction; D016019:Survival Analysis; D014019:Tissue Donors