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J. Hunter Mehaffey, MD, Eric J. Charles, MD, Ashish K

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Presentation on theme: "J. Hunter Mehaffey, MD, Eric J. Charles, MD, Ashish K"— Presentation transcript:

1 Airway pressure release ventilation during ex vivo lung perfusion attenuates injury 
J. Hunter Mehaffey, MD, Eric J. Charles, MD, Ashish K. Sharma, MBBS, PhD, Dustin T. Money, RRT-ACCS, Yunge Zhao, MD, PhD, Mark H. Stoler, MD, Christine L. Lau, MD, MBA, Curtis G. Tribble, MD, Victor E. Laubach, PhD, Mark E. Roeser, MD, Irving L. Kron, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 153, Issue 1, Pages (January 2017) DOI: /j.jtcvs Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Changes in Pao2/Fio2 ratios of the left lung over the course of the experiment. Pao2/Fio2 ratios were significantly higher in the APRV group after transplantation at both the 2-hour and 4-hour reperfusion times. Pao2, Partial pressure of oxygen; Fio2, inspired oxygen fraction; APRV, airway pressure release ventilation; EVLP, ex vivo lung perfusion. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Changes in Pao2/Fio2 ratios and dynamic compliance during EVLP. A, No significant differences in Pao2/Fio2 ratios during EVLP were observed between the control and APRV groups. B, Dynamic compliance throughout the 4 hours of EVLP was similar for both groups. Pao2, Partial pressure of oxygen; Fio2, inspired oxygen fraction; APRV, airway pressure release ventilation; EVLP, ex vivo lung perfusion. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Lung function and edema after transplantation. Pao2/Fio2 ratios (A) and dynamic lung compliance (B) were significantly improved in the APRV group at both 2 and 4 hours of post-transplant reperfusion. C, Pulmonary edema, as a percent weight change after 4 hours of reperfusion, was significantly reduced in the APRV group during EVLP versus control, but there was no significant difference after post-transplant reperfusion. Pao2, Partial pressure of oxygen; Fio2, inspired oxygen fraction; APRV, airway pressure release ventilation; EVLP, ex vivo lung perfusion. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 Lung tissue expression of proinflammatory cytokines in the left lungs of the APRV and control groups, as well as in post-EVLP right lungs. Several cytokines (IL-6 and IL-12) were significantly elevated in the control group but significantly reduced in the APRV group. IL, Interleukin; EVLP, ex vivo lung perfusion; APRV, airway pressure release ventilation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

6 Figure 5 Representative lung hematoxylin–eosin histology images from the control and APRV groups (A). Although lower in the APRV group, lung injury severity scores were not significantly different between the control and APRV groups (B). APRV, Airway pressure release ventilation. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

7 Figure 6 Representative images of immunohistochemistry staining for neutrophils in lung sections from both groups after transplantation and 4 hours of reperfusion (A). Neutrophil counts per high-powered field were significantly reduced in the APRV group versus control (B). APRV, Airway pressure release ventilation; HPF, high-powered field. The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

8 APRV during EVLP improves oxygenation post-transplant despite no difference in EVLP.
The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

9 Video 1 Porcine procurement and left lung transplant model. Video available at: The Journal of Thoracic and Cardiovascular Surgery  , DOI: ( /j.jtcvs ) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

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