title: Airway pressure release ventilation and successful lung donation.
abstract: OBJECTIVE
  Donor management with airway pressure release ventilation (APRV) improves oxygenation and increases lung donation while maintaining equivalent graft survival.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Private, tertiary care, level I trauma center.
  
  
  METHODS
  Forty-five consecutive organ donors.
  
  
  METHODS
  Management with assist/control ventilation (ACV) or APRV.
  
  
  METHODS
  Demographic characteristics, medical history, mode of brain death, and partial pressure of arterial oxygen (Pao(2))/fraction of inspired oxygen (Fio(2)) ratios on admission and after 100% oxygen challenge, percentage of lungs transplanted, and graft survival.
  
  
  RESULTS
  Twenty potential donors were managed with ACV and 25 were managed with APRV during the study period. The APRV patients were younger than the ACV patients (mean [SD] age, 34 [11] vs 41 [12] years, respectively; P = .05). Otherwise, there was no difference between the ACV and APRV groups with respect to demographic characteristics, medical history, or mode of brain death. Although the ACV and APRV groups had similar Pao(2)/Fio(2) ratios on admission and the mean time on the ventilator was the same, the APRV group had a higher Pao(2)/Fio(2) ratio than the ACV group (mean [SD], 498 [43] vs 334 [104] mm Hg, respectively; P < .001) after 100% oxygen challenge. The ACV group ultimately donated 7 of 40 potential lungs (18%) compared with 42 of 50 potential lungs (84%) in the APRV group (P < .001). There was no difference in the number of other organs per donor procured from the 2 groups. Survival of grafts managed with both APRV and ACV compared favorably with national averages.
  
  
  CONCLUSIONS
  The use of APRV prior to procurement may increase the rate of successful lung donation.
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, William Beaumont Hospitals, 3601 W. 13 Mile Road, Royal Oak, MI 48073, USA.
authors.forename: Kenny
authors.initials: K
authors.lastname: Hanna
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Seder
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Weinberger
authors.forename: Patty A
authors.initials: PA
authors.lastname: Sills
authors.forename: Michael
authors.initials: M
authors.lastname: Hagan
authors.forename: Randy J
authors.initials: RJ
authors.lastname: Janczyk
mesh_terms: D000328:Adult; D015331:Cohort Studies; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D019520:Living Donors; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011659:Pulmonary Gas Exchange; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome