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The intensive care unit oxygen challenge should not be used for donor lung function decision-making
David C McGiffin1, George L Zorn, K Randall Young
1Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA. david.mcgiffin@ccc.uab.edu
Summary
The intensive care unit oxygen challenge is an unreliable test for donor lung function. Intraoperative assessment and pulmonary venous PO2 are better indicators for lung transplantation suitability.
Area of Science:
- Cardiology
- Pulmonology
- Transplantation Medicine
Background:
- The intensive care unit (ICU) oxygen challenge is a standard test to assess donor lung viability.
- An arterial partial pressure of oxygen (PO2) below 300 mm Hg typically disqualifies lungs for transplantation.
Purpose of the Study:
- To compare the accuracy of the ICU oxygen challenge with intraoperative pulmonary vein PO2 measurements in evaluating donor lung function.
- To determine if intraoperative measurements can improve donor lung utilization.
Main Methods:
- A prospective study compared ICU oxygen challenge results with pulmonary vein PO2 in 91 deceased donors (182 lungs).
- Lungs were fully inflated with 100% oxygen (FIO2 1.0) before intraoperative sampling.
Main Results:
- 40 lungs showed a pulmonary vein PO2 >300 mm Hg despite failing the ICU oxygen challenge.
- 8 of these lungs were transplanted with excellent graft function and no primary graft failure or airway complications.
- The discrepancy between ICU and intraoperative PO2 was largest in donors with the lowest ICU PO2 values.
Conclusions:
- The ICU oxygen challenge is an unreliable predictor of donor lung function, especially with asymmetrical radiographic findings.
- Intraoperative assessment, including pulmonary venous PO2, is crucial for determining donor lung suitability.
- Adopting this strategy could increase the availability of donor lungs for transplantation.