Paries Marie, Boccheciampe Nicolas, Raux Mathieu, Riou Bruno, Langeron Olivier, Nicolas-Robin Armelle
Crit Care. 2012 Jul 3;16(4):R116. doi: 10.1186/cc11408.
Many potential lung transplants are lost because of hypoxemia during donor management. We hypothesized that the apnea test, necessary to confirm the diagnosis of brain death in potential lung donors, was involved in the decrease in the ratio of partial pressure of arterial O₂ to fraction of inspired O₂ (PaO₂/FiO₂) and that a single recruitment maneuver performed just after the apnea test can reverse this alteration.
In this case-control study, we examined the effectiveness of the recruitment maneuver with a comparison cohort of brain dead patients who did not receive the maneuver. Patients were matched one-to-one on the basis of initial PaO₂/FiO₂ and on the duration of mechanical ventilation before the apnea test. PaO₂/FiO₂ was measured before (T1), at the end (T2) and two hours after apnea test (T3).
Twenty-seven patients were included in each group. The apnea test was associated with a significant decrease in PaO₂/FiO₂ from 284 ± 98 to 224 ± 104 mmHg (P < 0.001). The decrease in PaO₂/FiO₂ between T1 and T3 was significantly lower in the recruitment maneuver group than in the control group (-4 (-68-57) vs -61 (-110--18) mmHg, P = 0.02). The number of potential donors with PaO₂/FiO₂ > 300 mmHg decreased by 58% (95% CI: 28-85%) in the control group vs 0% (95% CI: 0-34%) in the recruitment maneuver group (P < 0.001).
The apnea test induced a decrease in PaO₂/FiO₂ in potential lung donors. A single recruitment maneuver performed immediately after the apnea test can reverse this alteration and may prevent the loss of potential lung donors.
许多潜在的肺移植供体在供体管理期间因低氧血症而流失。我们推测，在潜在肺供体中用于确诊脑死亡所必需的 apnea 试验与动脉血氧分压与吸入氧分数之比（PaO₂/FiO₂）的降低有关，并且在 apnea 试验后立即进行单次肺复张手法可以逆转这种改变。
在这项病例对照研究中，我们通过与未接受该手法的脑死亡患者比较队列，研究了肺复张手法的有效性。患者根据初始 PaO₂/FiO₂ 和 apnea 试验前机械通气时间进行一对一匹配。在 apnea 试验前（T1）、试验结束时（T2）和试验后两小时（T3）测量 PaO₂/FiO₂。
每组纳入 27 例患者。apnea 试验与 PaO₂/FiO₂ 从 284±98 mmHg 显著降至 224±104 mmHg 相关（P<0.001）。肺复张手法组 T1 至 T3 期间 PaO₂/FiO₂ 的降低显著低于对照组（-4（-68 - 57） vs -61（-110 - -18）mmHg，P = 0.02）。对照组中 PaO₂/FiO₂>300 mmHg 的潜在供体数量减少了 58%（95%CI：28 - 85%），而肺复张手法组为 0%（95%CI：0 - 34%）（P<0.001）。
apnea 试验导致潜在肺供体的 PaO₂/FiO₂ 降低。在 apnea 试验后立即进行单次肺复张手法可以逆转这种改变，并可能防止潜在肺供体的流失。
