Lung Protective Ventilation and Primary Graft Dysfunction

Purpose It is unclear whether mechanical ventilator settings impact the risk of primary graft dysfunction (PGD) after lung transplantation. Importantly, ventilator settings are typically based on recipient rather than donor weight and height. In this study, we examined the relationship between lung protective ventilation based on donor size and PGD. Methods We analyzed 373 adult bilateral lung transplant recipients at our center between 1/2010 and 1/2017. We collected recipient, donor, and ventilator data after transplantation. We defined PGD as PGD 3 between 24 and 72 hours after transplantation and lung protective ventilation as a maximum tidal volume Results In univariate analysis, maximum tidal volume expressed as ml/kg of donor ideal body weight was associated with a significantly increased risk of PGD 3, (OR=1.42; 95%CI = 1.12-1.72, p>0.001). Similarly, lack of lung protective ventilation was associated with a significantly increased risk of PGD 3 (OR=5.56; 95%CI = 1.89-16.34, p=0.002). PGD risk factors that were significant in the univariate analysis were included in the multivariate analysis. In multivariate analysis, maximum tidal volume remained an independent predictor of PGD 3. Similarly, lack of lung protective ventilation remained an independent predictor of PGD 3. Conclusion Higher tidal volumes and not receiving lung protective ventilation were associated with an increased risk of PGD 3 between 24 and 72 hours. This suggests that adjusting ventilator settings based on donor size and lung protective ventilation after transplantation may mitigate the risk of PGD.