Am. J. Respir. Crit. Care Med., Vol 150, No. 2, Aug 1994, 558-560.
Fiberoptic bronchoscopy in brain-dead organ donors
B Riou, R Guesde, Y Jacquens, R Duranteau and P Viars
Department of Anesthesiology and Critical Care, Groupe Hospitalier Pitie-Salpetriere, Paris VI University, France.
Criteria for selecting lung donors include normal chest X-ray and adequate
gas exchange, but normal bronchoscopy is not always required. Thus, we
conducted a prospective study of fiberoptic bronchoscopy in 72 brain-dead
donors scheduled for multiple organ procurement. Chest X-ray was considered
normal in 37 donors (51%), and PaO2 was > 400 mm Hg with an FIO2 of 100%
in 34 donors (47%). Fiberoptic bronchoscopy was normal in only 24 donors
(33%). In the remaining 48 donors, inhalation of gastric contents (n = 26)
or blood (n = 17), pulmonary contusion (n = 5), or purulent bronchial
secretions (n = 4) were noted. In the 26 donors with normal chest X-ray and
PaO2 > 400 mm Hg with FIO2 of 100%, bronchoscopy was abnormal in 10
donors (38%). In 33 donors, arteriovenous difference in oxygen content (2.4
+/- 0.8 ml O2/100 ml), and pulmonary shunt (0.30 +/- 0.11, range 0.13-0.49)
were measured. In the 15 donors with PaO2 > 400 mm Hg, pulmonary shunt
was 0.23 +/- 0.07 (range 0.13-0.35). Our study suggests that chest X-ray
and arterial blood gas analysis are not sufficient, and that fiberoptic
bronchoscopy should be routinely performed to select potential lung donors.
Even in brain-dead donors, only the measurement of pulmonary shunt can
precisely assess pulmonary gas exchange.
