학술논문
Assessment of lung edema during ex-vivo lung perfusion by single transpulmonary thermodilution: A preliminary study in humans.
Document Type
Academic Journal
Author
Trebbia G; Department of Intensive Care Medicine,. Electronic address: gtrebbia@hotmail.com.; Sage E; Department of Thoracic Surgery.; Le Guen M; Department of Anesthesiology, and.; Roux A; Department of Pulmonary Medicine, Foch Hospital, Suresnes, France.; Soummer A; Department of Intensive Care Medicine.; Puyo P; Department of Thoracic Surgery.; Parquin F; Department of Thoracic Surgery.; Stern M; Department of Pulmonary Medicine, Foch Hospital, Suresnes, France.; Pham T; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Sorbonne Universités, Université Pierre et Marie Curie, Paris, France.; Sakka SG; Sorbonne Universités, Université Pierre et Marie Curie, Paris, France.; Cerf C; Department of Anesthesiology and Operative Intensive Care Medicine, Medical Center Cologne‒Merheim, University of Witten/Herdecke, Cologne, Germany.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 9102703 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1557-3117 (Electronic) Linking ISSN: 10532498 NLM ISO Abbreviation: J Heart Lung Transplant Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Single transpulmonary thermodilution (SD) with extravascular lung water index (EVLWI) could become a new tool to better assess lung graft edema during ex-vivo lung perfusion (EVLP). In this study we compare EVLWI with conventional methods to better select lungs during EVLP and to predict post-transplant primary graft dysfunction (PGD).
Methods: We measured EVLWI, arterial oxygen/fraction of inspired oxygen (P/F) ratio, and static lung compliance (SLC) during EVLP in an observational study. At the end of EVLP, grafts were accepted or rejected according to a standardized protocol blinded to EVLWI results. We compared the respective ability of EVLWI, P/F, and SLC to predict PGD. Mann-Whitney U-test, Fisher's exact test, and receiver-operating characteristic (ROC) curve data were used for analysis. p < 0.05 was considered statistically significant.
Results: Thirty-five lungs were evaluated by SD during EVLP. Three lungs were rejected for pulmonary edema. Thirty-two patients were transplanted, 8 patients developed Grade 2 or 3 PGD, and 24 patients developed Grade 0 or 1 PGD. In contrast to P/F ratio, SLC, and pulmonary artery pressure, EVLWI differed between these 2 populations (p < 0.001). The area under the ROC for EVLWI assessing Grade 2 or 3 PGD at the end of EVLP was 0.93. Donor lungs with EVLWI >7.5 ml/kg were more likely associated with a higher incidence of Grade 2 or 3 PGD at Day 3.
Conclusions: Increased EVLWI during EVLP was associated with PGD in recipients.
(Copyright © 2018 Elsevier Ltd. All rights reserved.)
Methods: We measured EVLWI, arterial oxygen/fraction of inspired oxygen (P/F) ratio, and static lung compliance (SLC) during EVLP in an observational study. At the end of EVLP, grafts were accepted or rejected according to a standardized protocol blinded to EVLWI results. We compared the respective ability of EVLWI, P/F, and SLC to predict PGD. Mann-Whitney U-test, Fisher's exact test, and receiver-operating characteristic (ROC) curve data were used for analysis. p < 0.05 was considered statistically significant.
Results: Thirty-five lungs were evaluated by SD during EVLP. Three lungs were rejected for pulmonary edema. Thirty-two patients were transplanted, 8 patients developed Grade 2 or 3 PGD, and 24 patients developed Grade 0 or 1 PGD. In contrast to P/F ratio, SLC, and pulmonary artery pressure, EVLWI differed between these 2 populations (p < 0.001). The area under the ROC for EVLWI assessing Grade 2 or 3 PGD at the end of EVLP was 0.93. Donor lungs with EVLWI >7.5 ml/kg were more likely associated with a higher incidence of Grade 2 or 3 PGD at Day 3.
Conclusions: Increased EVLWI during EVLP was associated with PGD in recipients.
(Copyright © 2018 Elsevier Ltd. All rights reserved.)