Lung Protective Ventilation based on Donor Size is associate
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Mechanical ventilation immediately after lung transplantation may impact the development of primary graft dysfunction (PGD), particularly in cases of donor-recipient size mismatch as ventilation is typically based on the recipient rather than donor size.

Researchers conducted a retrospective cohort study of adult bilateral lung transplant recipients. They defined donor-based lung-protective ventilation (dLPV) as 6-8ml/kg of donor ideal body weight and plateau pressure <30cmH2O. They calculated the donor-recipient predicted total lung capacity (pTLC) ratio and used logistic regression to examine relationships between pTLC ratio, dLPV, and PGD grade 3 at 48-72 hours.

The cohort included 373 recipients; 24 developed PGD grade 3 at 48-72 hours, and 213 received dLPV.

- The mean pTLC ratio was 1.04±0.18. dLPV was associated with significantly lower risks of PGD grade 3 and 1-year mortality.

- There was a significant association between the pTLC ratio and the risk of PGD grade 3, but this was attenuated by the use of dLPV.

dLPV is associated with decreased risk of PGD grade 3 at 48-72 hours and decreased 1-year mortality. Additionally, dLPV attenuates the association between pTLC and both PGD grade 3 and 1-year mortality. Donor-based ventilation strategies may help to mitigate the risk of PGD and other adverse outcomes associated with size mismatch after lung transplantation.

The Journal of Heart and Lung Transplantation
Source: https://doi.org/10.1016/j.healun.2021.06.016
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