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Perfusion pressure and positive end-expiratory pressure influence edema formation in isolated porcine lungs

Introduction

Preparation of lungs for transplantation includes perfusion with lung protection solution, typically by flushing the organ within short time periods leading to high fluidic (arterial) pressures. In an isolated porcine lung model we analyzed the influence of perfusion pressure during anterograde perfusion on the pulmonary edema formation during mechanical ventilation.

Methods

Isolated porcine lungs were ventilated in the volume control mode (SV 900 C; Siemens-Elema, Solna, Sweden) with a tidal volume of 3 ml/kg BW and with two positive end-expiratory pressure (PEEP) levels, 4 cmH2O and 8 cmH2O. After awaiting stationary ventilation conditions, flush perfusion with nutrition solution (PERFADEX; Vitrolife, Göteborg, Sweden) was applied at different fluidic (hydrostatic) pressures that were achieved by height differences between the lung and fluid reservoir of 100 cm (high level) or 55 cm (low level), respectively.

Results

During high-level perfusion, the maximal fluidic pressure reached 50 mmHg and lung mass increased by 130%. During low-level perfusion, the fluidic pressure reached 28 mmHg and lung mass increased only by 91% at PEEP of 4 cmH2O. Histological examination of the lung tissue confirmed that this increase in lung mass corresponded to an increase of interstitial edema. Using a PEEP of 8 cmH2O at low-level perfusion reduced the relative increase in lung mass to 30%. With increased PEEP the relative increase of lung mass caused by flush perfusion was reduced.

Conclusion

Flush perfusion at high fluidic pressure amplitudes leads to an increased lung mass compared with low fluidic pressure amplitudes. Edema formation in isolated lungs caused by flush perfusion is reduced using low-perfusion pressures in combination with high PEEP. Low flush perfusion pressures might be advantageous for preparation of lungs for transplantation.

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Schumann, S., Kirschbaum, A., Schliessmann, S. et al. Perfusion pressure and positive end-expiratory pressure influence edema formation in isolated porcine lungs. Crit Care 12, P286 (2008). https://doi.org/10.1186/cc6507

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Keywords

  • Pulmonary Edema
  • Fluidic Pressure
  • Perfusion Pressure
  • Edema Formation
  • Fluid Reservoir