Airway pressure release ventilation during ex vivo lung perfusion attenuates injury

J. Hunter Mehaffey, Eric J. Charles, Ashish K. Sharma, Dustin T. Money, Yunge Zhao, Mark H. Stoler, Christine L. Lau, Curtis G. Tribble, Victor E. Laubach, Mark E. Roeser, Irving L. Kron

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Objective Critical organ shortages have resulted in ex vivo lung perfusion gaining clinical acceptance for lung evaluation and rehabilitation to expand the use of donation after circulatory death organs for lung transplantation. We hypothesized that an innovative use of airway pressure release ventilation during ex vivo lung perfusion improves lung function after transplantation. Methods Two groups (n = 4 animals/group) of porcine donation after circulatory death donor lungs were procured after hypoxic cardiac arrest and a 2-hour period of warm ischemia, followed by a 4-hour period of ex vivo lung perfusion rehabilitation with standard conventional volume-based ventilation or pressure-based airway pressure release ventilation. Left lungs were subsequently transplanted into recipient animals and reperfused for 4 hours. Blood gases for partial pressure of oxygen/inspired oxygen fraction ratios, airway pressures for calculation of compliance, and percent wet weight gain during ex vivo lung perfusion and reperfusion were measured. Results Airway pressure release ventilation during ex vivo lung perfusion significantly improved left lung oxygenation at 2 hours (561.5 ± 83.9 mm Hg vs 341.1 ± 136.1 mm Hg) and 4 hours (569.1 ± 18.3 mm Hg vs 463.5 ± 78.4 mm Hg). Likewise, compliance was significantly higher at 2 hours (26.0 ± 5.2 mL/cm H2O vs 15.0 ± 4.6 mL/cm H2O) and 4 hours (30.6 ± 1.3 mL/cm H2O vs 17.7 ± 5.9 mL/cm H2O) after transplantation. Finally, airway pressure release ventilation significantly reduced lung edema development on ex vivo lung perfusion on the basis of percentage of weight gain (36.9% ± 14.6% vs 73.9% ± 4.9%). There was no difference in additional edema accumulation 4 hours after reperfusion. Conclusions Pressure-directed airway pressure release ventilation strategy during ex vivo lung perfusion improves the rehabilitation of severely injured donation after circulatory death lungs. After transplant, these lungs demonstrate superior lung-specific oxygenation and dynamic compliance compared with lungs ventilated with standard conventional ventilation. This strategy, if implemented into clinical ex vivo lung perfusion protocols, could advance the field of donation after circulatory death lung rehabilitation to expand the lung donor pool.

Original languageEnglish (US)
Pages (from-to)197-204
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume153
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

Keywords

  • airway pressure release ventilation
  • APRV
  • EVLP
  • ex vivo lung perfusion
  • ischemia reperfusion
  • lung injury
  • lung transplant

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Mehaffey, J. H., Charles, E. J., Sharma, A. K., Money, D. T., Zhao, Y., Stoler, M. H., Lau, C. L., Tribble, C. G., Laubach, V. E., Roeser, M. E., & Kron, I. L. (2017). Airway pressure release ventilation during ex vivo lung perfusion attenuates injury. Journal of Thoracic and Cardiovascular Surgery, 153(1), 197-204. https://doi.org/10.1016/j.jtcvs.2016.09.029