Department of Cardiovascular Sciences, Unit of Anesthesiology and Algology, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium.
Department of Cardiovascular Sciences, Unit of Anesthesiology and Algology, Katholieke Universiteit Leuven, Leuven, Belgium; Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
J Surg Res. 2019 Jul;239:300-308. doi: 10.1016/j.jss.2019.02.003. Epub 2019 Mar 19.
Ex vivo lung perfusion (EVLP) is developed to increase the quantity and quality of suitable grafts for lung transplantation. Standardly, lungs are mounted supine with the risk of fluid accumulation in the dorsal regions. Therefore, we investigated the impact of experimental prone position on graft function during EVLP.
Porcine lungs were mounted on a normothermic EVLP for 6 h in supine [S], (n = 7) or prone position [P], (n = 7). Physiology during EVLP was recorded. After EVLP, biopsies were assessed for wet-to-dry weight (W/D) ratios and pathology, broncho-alveolar lavage was measured, and the left lung was computed tomography (CT) scanned.
Physiological parameters were similar between both groups, despite a higher pulmonary vascular resistance in [P] (P = 0.0002). In [S], W/D ratios and CT density of dorsal areas were higher compared to ventral (P = 0.0017 and P = 0.053, respectively). In [P], W/D and CT density between ventral and dorsal regions were similar, meaning that pulmonary edema was distributed more homogeneously throughout the lung. Histology and cytokine levels in perfusate and broncho-alveolar lavage did not differ between both groups.
Prone positioning during EVLP is feasible and leads to more homogenous distribution of interstitial fluid. Supine position resulted in more concentrated edema accumulation in lower dependent regions.
体外肺灌注 (EVLP) 的发展旨在增加适合肺移植的供体肺数量和质量。标准情况下，肺以仰卧位安装，存在背部区域液体蓄积的风险。因此，我们研究了实验性俯卧位对 EVLP 期间供体肺功能的影响。
猪肺在仰卧位 [S]（n=7）或俯卧位 [P]（n=7）下进行了 6 小时的常温 EVLP。记录 EVLP 期间的生理学参数。EVLP 后，评估活检的湿干重 (W/D) 比和病理学，测量支气管肺泡灌洗，对左肺进行计算机断层扫描 (CT)。
尽管 [P] 组的肺血管阻力更高（P=0.0002），但两组的生理参数相似。在 [S] 中，与腹侧相比，背侧区域的 W/D 比和 CT 密度更高（P=0.0017 和 P=0.053）。在 [P] 中，腹侧和背侧区域之间的 W/D 和 CT 密度相似，这意味着肺水肿在整个肺中分布更均匀。灌洗液和支气管肺泡灌洗中的组织学和细胞因子水平在两组之间没有差异。
EVLP 期间的俯卧位是可行的，可导致间质液更均匀地分布。仰卧位导致下依赖区更集中的水肿积聚。
