A new way of monitoring mechanical ventilation by measurement of particle flow from the airways using Pexa method in vivo and during ex vivo lung perfusion in DCD lung transplantation

被引：14
作者：
Broberg E. [1 ]
Wlosinska M. [2 ]
Algotsson L. [1 ]
Olin A.-C. [3 ]
Wagner D. [4 ,5 ]
Pierre L. [2 ]
Lindstedt S. [2 ,5 ]
机构：
[1] Department of Cardiothoracic Anaesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund
[2] Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund
[3] Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg
[4] Experimental Medical Sciences, Lung Bioengineering and Regeneration, Lund University, Lund
[5] Wallenberg Center for Molecular Medicine, Lund University, Lund
来源：
Intensive Care Medicine Experimental | / 6卷 / 1期
关键词：
Ex Vivo Lung Perfusion (EVLP); Particle Flow; Donation After Circulatory Death (DCD); Large Tidal Volumes; Dipalmitoylphosphatidylcholine (DPPC);
D O I：
10.1186/s40635-018-0188-z
中图分类号：
学科分类号：
摘要：
Background: Different mechanical ventilation settings are known to affect lung preservation for lung transplantation. Measurement of particle flow in exhaled air may allow online assessment of the impact of ventilation before changes in the tissue can be observed. We hypothesized that by analyzing the particle flow, we could understand the impact of different ventilation parameters. Methods: Particle flow was monitored in vivo, post mortem, and in ex vivo lung perfusion (EVLP) in six porcines with the Pexa (particles in exhaled air) instrument. Volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) were used to compare small versus large tidal volumes. The surfactant lipids dipalmitoylphosphatidylcholine (DPPC) and phosphatidylcholine (PC) were quantified by mass spectrometry. Results: In vivo the particle mass in VCV1 was significantly lower than in VCV2 (p = 0.0186), and the particle mass was significantly higher in PCV1 than in VCV1 (p = 0.0322). In EVLP, the particle mass in VCV1 was significantly higher than in PCV1 (p = 0.0371), and the particle mass was significantly higher in PCV2 than in PCV1 (p = 0.0127). DPPC was significantly higher in EVLP than in vivo. Conclusions: Here, we introduce a new method for measuring particle flow during mechanical ventilation and confirm that these particles can be collected and analyzed. VCV resulted in a lower particle flow in vivo but not in EVLP. In all settings, large tidal volumes resulted in increased particle flow. We found that DPPC was significantly increased comparing in vivo with EVLP. This technology may be useful for developing strategies to preserve the lung and has a high potential to detect biomarkers. © 2018, The Author(s).
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共 22 条
[1]  
de Antonio D.G., Marcos R., Laporta R., Mora G., Garcia-Gallo C., Gamez P., Cordoba M., Moradiellos J., Ussetti P., Carreno M.C., Et al., Results of clinical lung transplant from uncontrolled non-heart-beating donors, J Heart Lung Transplant, 26, 5, pp. 529-534, (2007)
[2]  
Steen S., Sjoberg T., Pierre L., Liao Q., Eriksson L., Algotsson L., Transplantation of lungs from a non-heart-beating donor, Lancet, 357, 9259, pp. 825-829, (2001)
[3]  
De Oliveira N.C., Osaki S., Maloney J.D., Meyer K.C., Kohmoto T., D'Alessandro A.M., Love R.B., Lung transplantation with donation after cardiac death donors: long-term follow-up in a single center, J Thorac Cardiovasc Surg, 139, 5, pp. 1306-1315, (2010)
[4]  
Lindstedt S., Hlebowicz J., Koul B., Wierup P., Sjogren J., Gustafsson R., Steen S., Ingemansson R., Comparative outcome of double lung transplantation using conventional donor lungs and non-acceptable donor lungs reconditioned ex vivo, Interact Cardiovasc Thorac Surg, 12, 2, pp. 162-165, (2011)
[5]  
Lindstedt S., Eyjolfsson A., Koul B., Wierup P., Pierre L., Gustafsson R., Ingemansson R., How to recondition ex vivo initially rejected donor lungs for clinical transplantation: clinical experience from lund university hospital, J Transp Secur, 2011, (2011)
[6]  
Ingemansson R., Eyjolfsson A., Mared L., Pierre L., Algotsson L., Ekmehag B., Gustafsson R., Johnsson P., Koul B., Lindstedt S., Et al., Clinical transplantation of initially rejected donor lungs after reconditioning ex vivo, Ann Thorac Surg, 87, 1, pp. 255-260, (2009)
[7]  
Cypel M., Yeung J.C., Liu M., Anraku M., Chen F., Karolak W., Sato M., Laratta J., Azad S., Madonik M., Et al., Normothermic ex vivo lung perfusion in clinical lung transplantation, N Engl J Med, 364, 15, pp. 1431-1440, (2011)
[8]  
Cypel M., Yeung J.C., Keshavjee S., Novel approaches to expanding the lung donor pool: donation after cardiac death and ex vivo conditioning, Clin Chest Med, 32, 2, pp. 233-244, (2011)
[9]  
Cypel M., Yeung J.C., Hirayama S., Rubacha M., Fischer S., Anraku M., Sato M., Harwood S., Pierre A., Waddell T.K., Et al., Technique for prolonged normothermic ex vivo lung perfusion, J Heart Lung Transplant, 27, 12, pp. 1319-1325, (2008)
[10]  
Sanchez P.G., Bittle G.J., Burdorf L., Pierson R.N., Griffith B.P., State of art: clinical ex vivo lung perfusion: rationale, current status, and future directions, J Heart Lung Transplant, 31, 4, pp. 339-348, (2012)
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