GOLD
Trial question
What is the role of open lung protective ventilation strategy in deceased organ donors?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
44.0% female
56.0% male
N = 153
153 patients (67 female, 86 male).
Inclusion criteria: deceased organ donors, aged ≥ 13 years, with PaO2/FiO2 150-400 mmHg.
Key exclusion criteria: hepatitis B antigen positivity or hepatitis C viremia; hemodynamic instability requiring ≥ 3 vasopressors despite adequate fluid resuscitation; pneumomediastinum or untreated pneumothorax.
Interventions
N=74 open lung protective ventilation (tidal volume 8 mL/kg, PEEP 10 cmH20, protocolized recruitment maneuvers).
N=79 conventional ventilation (tidal volume 10 mL/kg, PEEP 5 cmH20, recruitment maneuvers only after vent disconnect).
Primary outcome
Donor lung utilization for transplantation
23%
22%
23.0 %
17.3 %
11.5 %
5.8 %
0.0 %
Open lung protective
ventilation
Conventional
ventilation
No significant
difference ↔
No significant difference in donor lung utilization for transplantation (23% vs. 22%; AD 1%, 95% CI -8.67 to 10.67).
Secondary outcomes
No significant difference in lung utilization for transplantation, potential donors (28% vs. 27%; AD 1%, 95% CI -76794.23 to 76796.23).
No significant difference in improvement in PaO2/FiO2 (69 mmHg vs. 74 mmHg; AD -5 mmHg, 95% CI -31.06 to 21.06).
Significantly greater improvement in atelectasis score (50% vs. 26%; AD 24%, 95% CI 1.06 to 46.94).
Safety outcomes
No significant differences in maximum number of vasopressors, serious adverse event.
Conclusion
In deceased organ donors, aged ≥ 13 years, with PaO2/FiO2 150-400 mmHg, open lung protective ventilation was not superior to conventional ventilation with respect to donor lung utilization for transplantation.
Reference
Lorraine B Ware, Tatsuki Koyama, Ciara M Shaver et al. A randomized trial of open lung protective ventilation compared to conventional mechanical ventilation in deceased organ donors. J Heart Lung Transplant. 2025 Apr 3:S1053-2498(25)01865-0. Online ahead of print.
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