Optimizing lung function during donor management through a multidisciplinary approach
Elizabeth Shipman1, Ashley Pacrem1, Marne Humphries1, Teah Vaden1.
1Organ Services, Nevada Donor Network, Las Vegas, NV, United States
Introduction: In current healthcare, a multi-disciplinary approach is taken in critical care to ensure all specialties can offer their training and expertise in the care of every patient. In organ donation, and specifically donor management, having a team of Procurement Transplant Coordinators (PTCs) that is comprised similarly ensures that optimal results can be achieved through a varied knowledge base. Traditionally, this has been heavily weighted with Registered Nurses with critical care experience. We propose that including Registered Respiratory Therapists (RRTs) as PTCs can broaden the base of expertise of the team and maximize successful lung transplantation. Additionally, the incorporation of different modes and modalities of ventilation with a physiological approach to lung recruitment has successfully proven an increase in lung optimization.
Method: To fully understand the positive impact of RRTs in lung recruitment, we looked at the upward trend of the Horowitz index for Lung Function (P/F ratio) with a subject United States based Organ Procurement Organization and how it correlated with an increasing number of PTCs that are licensed and registered Respiratory Therapists. Four RRTs were onboarded to the donor management team during 2020 and 2021. Comparing the results from previous years, data showed a related increase in lung recruitment and optimization per year with RRTs working as PTCs.
Results: Evidence demonstrated a correlation of the increase in lung procurement and transplantation numbers mirroring an increase in RRTs in the role of PTCs. Improvements to P/F ratios were compared at the beginning of the case to the final P/F ratio prior to OR. From January 1, 2018-December 31, 2019 there were 89 donors who were brought to the operating room for lung procurement with the intent of transplant. The median and mean improvement to P/F ratios were +0.83 and +0.83, respectively. From January 1, 2020- December 31, 2021 there were 75 donors who were brought to the operating room for lung procurement with the intent of transplant. The median and mean improvement to P/F ratios were +1.04 and +1.32, respectively. This proved a 25.3% increase for the median PF ratio and a 59% increase to the mean PF ratio.
Conclusion: Our research supports that PTCs who are licensed and experienced Respiratory Therapists being proficient in lung physiology, recruitment, and ventilation strategies contribute to an increase in lung optimization. With having specific organ expertise, RRTs have proven to be a vital asset while sharing knowledge with the entire multi-disciplinary team.
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