THE EFFECT OF FLUID THERAPY ON ALVEOLAR-ARTERIAL OXYGEN GRADIENT IN BRAIN-DEAD ORGAN DONORS

Lung transplantation is limited by a shortage of suitable lung donors. Fluid loading is widely used to increase blood pressure during donor maintenance. In a prospective study, we investigated the effect of flu id loading with lactated Ringers solution on pulmonary function in 26 brain-dead adult organ donors. In all patients, the initial central ve nous pressure (CVP) was <6 mmHg. In 13 patients, a CVP of 8-10 mmHg wa s achieved and maintained for 90 min by an infusion of lactated Ringer s solution. This resulted in a significant increase (P<0.05) in the al veolar arterial oxygen gradient. In 13 patients, the CVP was maintaine d at 4-6 mmHg for 90 min by, if necessary, an infusion of lactated Rin gers solution. In these patients, no significant change in the alveola r arterial oxygen gradient occurred. Pulmonary gas exchange has been s hown to be a reliable means of evaluating donor lung function. We conc lude that crystalloid fluid loading to a CVP of 8-10 mmHg may be delet erious to lung function and should be avoided in potential lung donors .