Ex Vivo Lung Perfusion Rehabilitates Sepsis-Induced Lung Injury

J. Hunter Mehaffey, Eric J. Charles, Ashish K. Sharma, Morgan Salmon, Dustin Money, Sarah Schubert, Mark H. Stoler, Curtis G. Tribble, Victor E. Laubach, Mark E. Roeser, Irving L. Kron

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Background Sepsis is the number one cause of lung injury in adults. Ex vivo lung perfusion (EVLP) is gaining clinical acceptance for donor lung evaluation and rehabilitation and may expand the use of marginal organs for transplantation. We hypothesized that 4 hours of normothermic EVLP would improve compliance and oxygenation in a porcine model of sepsis-induced lung injury. Methods We used intravenous lipopolysaccharide (LPS) to induce a systemic inflammatory response in a porcine model of lung injury. Two groups of 4 animals each received a 2-hour infusion of LPS through the external jugular vein. Serial measurements of blood gases were performed every 30 minutes until the partial pressure of oxygen/fraction of inspired oxygen ratio dropped below 150 on two consecutive readings. Lungs were then randomized to treatment with 4 hours of normothermic EVLP with STEEN Solution (XVIVO Perfusion Inc, Englewood, CO) or 4 additional hours of in vivo perfusion (control). Airway pressures and blood gases were recorded for calculation of dynamic lung compliance and partial pressure of oxygen/fraction of inspired oxygen ratios. EVLP was performed with hourly recruitment maneuvers and oxygen challenge. Results All animals reached a partial pressure of oxygen/fraction of inspired oxygen ratio of less than 150 mm Hg within 3 hours after start of the LPS infusion. Oxygenation and compliance in the control animals continued to decline during the 4-hour in vivo perfusion period, and 3 of the 4 animals died of severe hypoxia within 4 hours. The EVLP group demonstrated significant improvements hour 1 to hour 4 in oxygenation (365.8 ± 53.0 vs 584.4 ± 21.0 mm Hg, p = 0.02) and dynamic compliance (9.0 ± 2.8 vs 15.0 ± 3.6, p = 0.02 mL/cm H 2 O). Conclusions EVLP successfully rehabilitated LPS-induced lung injury in this preclinical porcine model and may thus provide a means to rehabilitate many types of acute lung injury.

Original languageEnglish (US)
Pages (from-to)1723-1729
Number of pages7
JournalAnnals of Thoracic Surgery
Volume103
Issue number6
DOIs
StatePublished - Jun 2017
Externally publishedYes

ASJC Scopus subject areas

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

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    Mehaffey, J. H., Charles, E. J., Sharma, A. K., Salmon, M., Money, D., Schubert, S., Stoler, M. H., Tribble, C. G., Laubach, V. E., Roeser, M. E., & Kron, I. L. (2017). Ex Vivo Lung Perfusion Rehabilitates Sepsis-Induced Lung Injury. Annals of Thoracic Surgery, 103(6), 1723-1729. https://doi.org/10.1016/j.athoracsur.2017.01.018