Recrutamento alveolar pós teste de apnéia

Vista frontal Hôpital Pitié Salpêtrière, entrada pelo Bd de l´Hôpital, Paris, França

Muito interessante a abordagem do grupo do Hôpital Pitié-Salpêtrière sobre recrutamento alveolar em paciente provável doador de pulmão.

Após teste de apnéia, há considerável queda da relação PaO2/FiO2 e essa pode ser melhorada com o recrutamento. Isso serve para todos os doadores. A garantia de boa relação ventilação perfusão vai nos ajudar em todos os órgãos!

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Benefit of a single recruitment maneuver after an apnea test for the diagnosis of brain death


Paries M, Boccheciampe N, Raux M, Riou B, Langeron O, Nicolas-Robin A



Introduction: Many potential lung transplants are lost because of hypoxemia during donor
management. We hypothesized that the apnea test, necessary to confirm the diagnosis of brain
death in potential lung donors, was involved in the decrease in the ratio of partial pressure of
arterial O2 to fraction of inspired O2 (PaO2/FiO2) and that a single recruitment maneuver
performed just after the apnea test can reverse this alteration.

Methods: In this case-control study, we examined the effectiveness of the recruitment
maneuver with a comparison cohort of brain dead patients who did not receive the maneuver.
Patients were matched one-to-one on the basis of initial PaO2/FiO2 and on the duration of
mechanical ventilation before the apnea test. PaO2/FiO2 was measured before (T1), at the end
(T2) and two hours after apnea test (T3).

Results: Twenty-seven patients were included in each group. The apnea test was associated
with a significant decrease in PaO2/FiO2 from 284 ± 98 to 224 ± 104 mmHg (P<0.001). The
decrease in PaO2/FiO2 between T1 and T3 was significantly lower in the recruitment
maneuver group than in the control group (-4 (-68 – 57) vs -61 (-110 – -18) mmHg, P=0.02).
The number of potential donors with PaO2/FiO2 > 300 mmHg decreased by 58% (95% CI:
28-85%) in the control group vs 0% (95% CI: 0-34%) in the recruitment maneuver group
(P<0.001).

Conclusions: The apnea test induced a decrease in PaO2/FiO2 in potential lung donors. A
single recruitment maneuver performed immediately after the apnea test can reverse this
alteration and may prevent the loss of potential lung donors.