The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

EX-VIVO LUNG PERFUSION AND VENTILATION

Christine Perino1, Paul F. Nuccio1, Phillip Camp2, Zain Khalpey3; 1Pulmonary & Respiratory Care, Brigham and Women’s Hospital, Boston, MA; 2Thoracic Surgery, Brigham and Women’s Hospital, Boston, MA; 3Department of Surgery, Brigham and Women’s Hospital, Boston, MA

Introduction: Eighty percent of lungs donated for transplantation are rejected using UNOS criteria. Lungs from marginal donors have been successfully used for transplantation for at least a decade and the concept is gradually gaining acceptance. Closed circuit perfusion of the lung mimics in-vivo conditions. The ventilated lung is perfused with a 15% deoxygenated suspension of red cells in solution. From perfusion circuitry monitors, critical parameters of gas exchange, pulmonary vascular resistance and other variables under normothermic conditions can be measured. A six hour protocol of ventilation and perfusion strategies is performed to resuscitate otherwise discarded lungs for human lung transplantation. Case Summary: Double lungs (donor) from a 71 inch male with COPD were harvested and prepared for transport using the New England Organ Bank (NEOB)protocol. Upon arrival to our institution, they were placed on a sterile field; a “left atrium” was fashioned. Both the left atrium and pulmonary artery were cannulated. The lungs were “de-aired” using retrograde perfusion initially. An 8.5 endotracheal tube was placed and clamped. Once a temperature of 32 degrees Celsius was reached in the perfusion circuit, ventilation of the lungs began using a PB 840. Tidal volumes of 6-8ml/kg, 5cmH2O PEEP, Frequency 7, FiO2 of .21 were protocolized settings. Recruitment maneuvers using 20cmH2O of PEEP for 15 seconds were performed – keeping PAP’s < 25mmHg, every hour. The FiO2 was increased ten minutes post recruitment (oxygen challenge), with venous and arterial blood gases drawn for evaluation. For edema prevention, goal LA pressures were 3-5mmHg and PA pressures were 10-15 mmHg. There were lung biopsies performed during the case (1hr, 4hr and 6hrs during perfusion). Peak inspiratory pressure suddenly increased, and suctioning via sterile Ballard was performed around the 4, 4.5, and 5 hour marks, thick yellow secretions were obtained. Discussion: Per MD evaluation, lung function was improved post protocol. The highest PaO2 was obtained at the end of the study. Compliance improved post recruitment (66L/cmH2O-113L/cmH2O). All criteria involved suggested an improvement in lung function. Sponsored Research - None

CHEST June 2002 vol. 121 no. 6 2029-2031