What are the methods used to optimise the respiratory system of the potential organ donor? Which physiological values should be targeted?

System
Methods for Optimisation
Targets
Respiratory System
  • Lung recruitment maneuvers and PEEP following apnoea test
  • Continue VAP prevention measures:
    • 30-45 degrees head up tilt
    • Tight endotracheal cuff
    • Patient positioning as per unit protocol
  • Review ventilation, ensure lung protective strategy:
    • Tidal volumes 4-8 ml/kg ideal body weight
    • Optimum PEEP (5-10 cmH2O)
    • Peak inspiratory pressures limited to <30 cmH2O
    • Minimize FiO2 if lungs are to be transplanted
  • Reinstate chest physiotherapy and regular suctioning
  • If required perform bronchoscopy, bronchial lavage and toilet for therapeutic purposes
  • Avoid high extravascular lung water:
    • Early use of methylprednisolone 15 mg/kg given intravenously
    • Avoid positive fluid balance
    • Perform CXR (post recruitment procedure where possible)
  • PaO2: 10 kPa FiO2 <0.4 as able)
  • PaCO2: 5 – 6.5 kPa (or higher as long as pH >7.25)
  • Tidal Volumes: 4-8 ml/kg ideal body weight
  • PEEP: 5-10 cmH2O
  • Peak inspiratory pressure: <30 cmH2O