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Protective Mechanical Ventilation in Brain Dead Organ Donors

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Abstract

Mechanical ventilation is the procedure to assist or replace spontaneous breathing in all clinical conditions where the function of the lungs to remove carbon dioxide and supply oxygen is compromised. Originally developed to manage the respiratory consequences of anesthesia [1], the use of mechanical ventilation to manage patients with acute respiratory failure during the 1952 epidemic of poliomyelitis in Copenhagen decreased mortality from 80 to 40 % [2]. Since then mechanical ventilation became a mainstay for patients with acute respiratory failure, including patients with severe brain injury and brain dead subjects who may become potential organ donors.

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References

  1. Hedenstierna G (2002) Airway closure, atelectasis and gas exchange during anaesthesia. Minerva Anestesiol 68(5):332–336

    CAS  PubMed  Google Scholar 

  2. Ibsen B (1954) The anaesthetist’s viewpoint on the treatment of respiratory complications in poliomyelitis during the epidemic in Copenhagen, 1952. Proc R Soc Med 47(1):72–74

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Ware LB, Wang Y, Fang X et al (2002) Assessment of lungs rejected for transplantation and implications for donor selection. Lancet 360(9333):619–620

    Article  PubMed  Google Scholar 

  4. Van Raemdonck D, Neyrinck A, Verleden GM et al (2009) Lung donor selection and management. Proc Am Thorac Soc 6(1):28–38

    Article  PubMed  Google Scholar 

  5. Theodore J, Robin ED (1975) Pathogenesis of neurogenic pulmonary oedema. Lancet 2(7938):749–751

    Article  CAS  PubMed  Google Scholar 

  6. Rosner MJ, Newsome HH, Becker DP (1984) Mechanical brain injury: the sympathoadrenal response. J Neurosurg 61(1):76–86

    Article  CAS  PubMed  Google Scholar 

  7. van Loon J, Shivalkar B, Plets C et al (1993) Catecholamine response to a gradual increase of intracranial pressure. J Neurosurg 79(5):705–709

    Article  PubMed  Google Scholar 

  8. McClellan MD, Dauber IM, Weil JV (1989) Elevated intracranial pressure increases pulmonary vascular permeability to protein. J Appl Physiol (1985) 67(3):1185–1191

    CAS  Google Scholar 

  9. Smith WS, Matthay MA (1997) Evidence for a hydrostatic mechanism in human neurogenic pulmonary edema. Chest 111(5):1326–1333

    Article  CAS  PubMed  Google Scholar 

  10. Avlonitis VS, Fisher AJ, Kirby JA et al (2003) Pulmonary transplantation: the role of brain death in donor lung injury. Transplantation 75(12):1928–1933

    Article  PubMed  Google Scholar 

  11. Habgood MD, Bye N, Dziegielewska KM et al (2007) Changes in blood–brain barrier permeability to large and small molecules following traumatic brain injury in mice. Eur J Neurosci 25(1):231–238

    Article  CAS  PubMed  Google Scholar 

  12. McKeating EG, Andrews P, Signorini DF et al (1997) Transcranial cytokine gradients in patients requiring intensive care after acute brain injury. Br J Anaesth 78(5):520–523

    Article  CAS  PubMed  Google Scholar 

  13. Morganti-Kossmann MC, Rancan M, Stahel PF et al (2002) Inflammatory response in acute traumatic brain injury: a double-edged sword. Curr Opin Crit Care 8(2):101–105

    Article  PubMed  Google Scholar 

  14. Hutchinson PJ, O’Connell MT, Rothwell NJ et al (2007) Inflammation in human brain injury: intracerebral concentrations of IL-1alpha, IL-1beta, and their endogenous inhibitor IL-1ra. J Neurotrauma 24(10):1545–1557

    Article  PubMed  Google Scholar 

  15. Rhodes JK, Andrews PJ, Holmes MC et al (2002) Expression of interleukin-6 messenger RNA in a rat model of diffuse axonal injury. Neurosci Lett 335(1):1–4

    Article  CAS  PubMed  Google Scholar 

  16. Mascia L, Mastromauro I, Viberti S et al (2009) Management to optimize organ procurement in brain dead donors. Minerva Anestesiol 75(3):125–133

    CAS  PubMed  Google Scholar 

  17. Pelosi P, Rocco PR (2011) The lung and the brain: a dangerous cross-talk. Crit Care 15(3):168

    Article  PubMed  PubMed Central  Google Scholar 

  18. Yildirim E, Kaptanoglu E, Ozisik K et al (2004) Ultrastructural changes in pneumocyte type II cells following traumatic brain injury in rats. Eur J Cardiothorac Surg 25(4):523–529

    Article  PubMed  Google Scholar 

  19. Yildirim E, Ozisik K, Ozisik P et al (2006) Apoptosis-related gene Bcl-2 in lung tissue after experimental traumatic brain injury in rats. Heart Lung Circ 15(2):124–129

    Article  CAS  PubMed  Google Scholar 

  20. Wu S, Fang CX, Kim J et al (2006) Enhanced pulmonary inflammation following experimental intracerebral hemorrhage. Exp Neurol 200(1):245–249

    Article  CAS  PubMed  Google Scholar 

  21. Toung TJ, Chang Y, Lin J et al (2005) Increases in lung and brain water following experimental stroke: effect of mannitol and hypertonic saline. Crit Care Med 33(1):203–208; discussion 259–260

    Article  CAS  PubMed  Google Scholar 

  22. Kalsotra A, Zhao J, Anakk S et al (2007) Brain trauma leads to enhanced lung inflammation and injury: evidence for role of P4504Fs in resolution. J Cereb Blood Flow Metab 27(5):963–974

    CAS  PubMed  Google Scholar 

  23. Quilez ME, Fuster G, Villar J et al (2011) Injurious mechanical ventilation affects neuronal activation in ventilated rats. Crit Care 15(3):R124

    Article  PubMed  PubMed Central  Google Scholar 

  24. Touho H, Karasawa J, Shishido H et al (1989) Neurogenic pulmonary edema in the acute stage of hemorrhagic cerebrovascular disease. Neurosurgery 25(5):762–768

    Article  CAS  PubMed  Google Scholar 

  25. Rogers FBMDF, Shackford SRMDF, Trevisani GTMD et al (1995) Neurogenic pulmonary edema in fatal and nonfatal head injuries. J Trauma 39(5):860–868

    Article  CAS  PubMed  Google Scholar 

  26. Mascia L, Sakr Y, Pasero D et al (2008) Extracranial complications in patients with acute brain injury: a post-hoc analysis of the SOAP study. Intensive Care Med 34(4):720–727

    Article  PubMed  Google Scholar 

  27. Slutsky AS, Ranieri VM (2014) Ventilator-induced lung injury. N Engl J Med 370(10):980

    PubMed  Google Scholar 

  28. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network (2000) N Engl J Med 342(18):1301–1308

    Google Scholar 

  29. Serpa Neto A, Cardoso SO, Manetta JA et al (2012) Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA 308(16):1651–1659

    Article  CAS  PubMed  Google Scholar 

  30. Lopez-Aguilar J, Villagra A, Bernabe F et al (2005) Massive brain injury enhances lung damage in an isolated lung model of ventilator-induced lung injury. Crit Care Med 33(5):1077–1083

    Article  PubMed  Google Scholar 

  31. Heuer JF, Pelosi P, Hermann P et al (2011) Acute effects of intracranial hypertension and ARDS on pulmonary and neuronal damage: a randomized experimental study in pigs. Intensive Care Med 37(7):1182–1191

    Article  PubMed  PubMed Central  Google Scholar 

  32. Krebs J, Tsagogiorgas C, Pelosi P et al (2014) Open lung approach with low tidal volume mechanical ventilation attenuates lung injury in rats with massive brain damage. Crit Care 18(2):R59

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gajic O, Dabbagh O, Park PK et al (2011) Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. Am J Respir Crit Care Med 183(4):462–470

    Article  PubMed  Google Scholar 

  34. Rincon F, Ghosh S, Dey S et al (2012) Impact of acute lung injury and acute respiratory distress syndrome after traumatic brain injury in the United States. Neurosurgery 71(4):795–803

    Article  PubMed  Google Scholar 

  35. Mascia L, Mastromauro I, Viberti S (2008) High tidal volume as a predictor of acute lung injury in neurotrauma patients. Minerva Anestesiol 74(6):325–327

    CAS  PubMed  Google Scholar 

  36. Cypel M, Yeung JC, Liu M et al (2011) Normothermic ex vivo lung perfusion in clinical lung transplantation. N Engl J Med 364(15):1431–1440

    Article  CAS  PubMed  Google Scholar 

  37. Botha P, Fisher AJ, Dark JH (2006) Marginal lung donors: a diminishing margin of safety? Transplantation 82(10):1273–1279

    Article  PubMed  Google Scholar 

  38. Botha P, Trivedi D, Weir CJ et al (2006) Extended donor criteria in lung transplantation: impact on organ allocation. J Thorac Cardiovasc Surg 131(5):1154–1160

    Article  PubMed  Google Scholar 

  39. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons (2007) Guidelines for the management of severe traumatic brain injury. J Neurotrauma 24(Suppl 1):S1–S106

    Google Scholar 

  40. Rosengard BR, Feng S, Alfrey EJ et al (2002) Report of the Crystal City meeting to maximize the use of organs recovered from the cadaver donor. Am J Transplant 2(8):701–711

    Article  PubMed  Google Scholar 

  41. Mascia L, Pasero D, Slutsky AS et al (2010) Effect of a lung protective strategy for organ donors on eligibility and availability of lungs for transplantation: a randomized controlled trial. JAMA 304(23):2620–2627

    Article  CAS  PubMed  Google Scholar 

  42. Angel LF, Levine DJ, Restrepo MI et al (2006) Impact of a lung transplantation donor-management protocol on lung donation and recipient outcomes. Am J Respir Crit Care Med 174(6):710–716

    Article  PubMed  Google Scholar 

  43. Noiseux N, Nguyen BK, Marsolais P et al (2009) Pulmonary recruitment protocol for organ donors: a new strategy to improve the rate of lung utilization. Transplant Proc 41(8):3284–3289

    Article  CAS  PubMed  Google Scholar 

  44. Minambres E, Coll E, Duerto J et al (2014) Effect of an intensive lung donor-management protocol on lung transplantation outcomes. J Heart Lung Transplant 33(2):178–184

    Article  PubMed  Google Scholar 

  45. Ware LB, Landeck M, Koyama T et al (2014) A randomized trial of the effects of nebulized albuterol on pulmonary edema in brain-dead organ donors. Am J Transplant 14(3):621–628

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Bansal R, Esan A, Hess D et al (2014) Mechanical ventilatory support in potential lung donor patients. Chest 146(1):220–227

    Article  PubMed  Google Scholar 

  47. Rech TH, Moraes RB, Crispim D et al (2013) Management of the brain-dead organ donor: a systematic review and meta-analysis. Transplantation 95(7):966–974

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Dipartimento di Scienze Chirurgiche, Università di Torino, A.O.U. Città della Salute e della Scienza di, Torino, Italy

    Chiara Faggiano MD, Vito Fanelli MD, PhD & Pierpaolo Terragni MD

  2. Dipartimento di Scienze e Biotecnologie Medico Chirurgiche, Sapienza Università di Roma, Corso della Repubblica 79, Latina, 04100, Italy

    Luciana Mascia MD, PhD

Authors
  1. Chiara Faggiano MD
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  2. Vito Fanelli MD, PhD
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  3. Pierpaolo Terragni MD
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  4. Luciana Mascia MD, PhD
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Corresponding author

Correspondence to Luciana Mascia MD, PhD .

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Editors and Affiliations

  1. ASST Santi Paolo e Carlo, Responsabile SC Anestesia, e Rianimazione, Milano, Italy

    Davide Chiumello

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Faggiano, C., Fanelli, V., Terragni, P., Mascia, L. (2016). Protective Mechanical Ventilation in Brain Dead Organ Donors. In: Chiumello, D. (eds) Topical Issues in Anesthesia and Intensive Care. Springer, Cham. https://doi.org/10.1007/978-3-319-31398-6_6

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  • DOI: https://doi.org/10.1007/978-3-319-31398-6_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-31396-2

  • Online ISBN: 978-3-319-31398-6

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