Parto S, Shafaghi S, Khoddami-Vishteh H-R, Makki S Mohammad, Abbasidezfuli A, Daneshvar A, Sheikhy K, Faeghi J, Ghorbani F, Parsa T, Najafizadeh K
Lung Transplantation Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Transplant Proc. 2013;45(10):3531-3. doi: 10.1016/j.transproceed.2013.09.001.
Because of the shortage of lungs for transplantation, finding the suitable lungs in brain-dead donors is an important issue. Recruitment maneuver is a strategy aimed at re-expanding collapsed and edematous lung tissue. The aim of this study was to assess the efficacy of this maneuver on improving marginal lungs for transplantation.
From 127 brain-dead potential donor which were evaluated for lung donation in Masih Daneshvari Organ Procurement Unit of Tehran, Iran, 31 (25%) had marginal lungs for transplantation. These donors had normal chest X ray or bilateral infiltration and had PaO2 200-300 mm Hg with FIO2 100%. The recruitment maneuver was performed and arterial blood gas was obtained before and after maneuver. The maneuver lasts for 2 hours with continuous check of O2 saturation and patient's hemodynamic during. Finally, patients with normal bronchoscopy and PaO2/FIO2 >300 mm Hg were considered good candidates for lung transplantation. The frequency (%) and mean ± SD were used for description of variables and the Wilcoxon test was used for comparison between pre- and post-maneuver PaO2 with FIO2 100%.
The mean ± SD of PaO2/FIO2 with 100% FIO2 of patients before and after recruitment were 239 ± 62 and 269 ± 91, respectively. Recruitment maneuver could convert 10 marginal lungs (32%) to appropriate ones (PaO2 > 300) and finally 8 lungs were transplanted.
Findings of this study showed that recruitment maneuver could convert inappropriate lungs to appropriate ones in one third of brain-dead patients who had marginal lung condition. So, it is recommended that this maneuver is considered in the assessment protocol of lungs for donation.
由于肺移植供体短缺，在脑死亡供体中寻找合适的肺是一个重要问题。肺复张手法是一种旨在重新扩张萎陷和水肿肺组织的策略。本研究的目的是评估该手法对改善边缘性供肺用于移植的效果。
在伊朗德黑兰马西赫·达内什瓦里器官获取单位对127名潜在脑死亡供体进行肺捐赠评估，其中31名（25%）有边缘性供肺用于移植。这些供体胸部X线正常或双侧浸润，吸入氧分数（FIO2）为100%时动脉血氧分压（PaO2）为200 - 300 mmHg。进行肺复张手法，并在手法前后采集动脉血气。该手法持续2小时，期间持续监测氧饱和度和患者血流动力学。最后，支气管镜检查正常且PaO2/FIO2>300 mmHg的患者被认为是肺移植的良好候选者。变量用频率（%）和均值±标准差描述，采用Wilcoxon检验比较手法前后FIO2为100%时的PaO2。
肺复张前后FIO2为100%时患者的PaO2/FIO2均值±标准差分别为239±62和269±91。肺复张手法可使10个边缘性供肺（32%）转变为合适的供肺（PaO2>300），最终8个肺被用于移植。
本研究结果表明，肺复张手法可使三分之一有边缘性肺状况的脑死亡患者的不合适供肺转变为合适供肺。因此，建议在肺捐赠评估方案中考虑该手法。
