Ventilatory Management During Normothermic Ex Vivo Lung Perfusion: Effects on Clinical Outcomes

Pier Paolo Terragni, Vito Fanelli, Massimo Boffini, Claudia Filippini, Paola Cappello, Davide Ricci, Lorenzo Del Sorbo, Chiara Faggiano, Luca Brazzi, Giacomo Frati, Federico Venuta, Luciana Mascia, Mauro Rinaldi, V. M. Ranieri

Research output: Contribution to journalArticle

Abstract

BACKGROUND: During ex vivo lung perfusion (EVLP), fixed ventilator settings and monitoring of compliance are used to prevent ventilator-induced lung injury (VILI). Analysis of the airway pressure-time curve (stress index) has been proposed to assess the presence of VILI. We tested whether currently proposed ventilator settings expose lungs to VILI during EVLP and whether the stress index could identify VILI better than compliance. METHODS: Flow, volume, and airway opening pressure were collected continuously during EVLP. Durations of mechanical ventilation, intensive care unit (ICU) and hospital lengths of stay were recorded in lung recipients. RESULTS: Fourteen lungs underwent EVLP and were transplanted. In 5 lungs, 95 ± 2% of the stress index values were within the 0.95 to 1.05 range (protected); in the remaining nine lungs, 69 ± 1% of the values were greater than 1.05 and 15 ± 3% were less than 0.95 (nonprotected). There was a significant (P <0.05) increase in cytokine concentrations after 4 hours of EVLP in the nonprotected lungs. Durations of mechanical ventilation, ICU, and hospital lengths of stay were shorter in recipients of protected than that of nonprotected lungs (P <0.05). There was no correlation between compliance during EVLP and duration of mechanical ventilation or ICU and hospital lengths of stay in recipients, but the stress index during EVLP was significantly correlated with the duration of mechanical ventilation and with ICU and hospital lengths of stay (P <0.05). CONCLUSIONS: This small, preliminary study shows that ventilator settings currently proposed for EVLP may expose lungs to VILI. Use of the stress index to personalize ventilator settings needs to be tested in further clinical studies.

Original languageEnglish
JournalTransplantation
DOIs
Publication statusAccepted/In press - Oct 1 2015

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Perfusion
Lung
Ventilator-Induced Lung Injury
Length of Stay
Mechanical Ventilators
Artificial Respiration
Intensive Care Units
Compliance
Pressure
Cytokines

ASJC Scopus subject areas

  • Transplantation

Cite this

Terragni, P. P., Fanelli, V., Boffini, M., Filippini, C., Cappello, P., Ricci, D., ... Ranieri, V. M. (Accepted/In press). Ventilatory Management During Normothermic Ex Vivo Lung Perfusion: Effects on Clinical Outcomes. Transplantation. https://doi.org/10.1097/TP.0000000000000929

Ventilatory Management During Normothermic Ex Vivo Lung Perfusion : Effects on Clinical Outcomes. / Terragni, Pier Paolo; Fanelli, Vito; Boffini, Massimo; Filippini, Claudia; Cappello, Paola; Ricci, Davide; Del Sorbo, Lorenzo; Faggiano, Chiara; Brazzi, Luca; Frati, Giacomo; Venuta, Federico; Mascia, Luciana; Rinaldi, Mauro; Ranieri, V. M.

In: Transplantation, 01.10.2015.

Research output: Contribution to journalArticle

Terragni, PP, Fanelli, V, Boffini, M, Filippini, C, Cappello, P, Ricci, D, Del Sorbo, L, Faggiano, C, Brazzi, L, Frati, G, Venuta, F, Mascia, L, Rinaldi, M & Ranieri, VM 2015, 'Ventilatory Management During Normothermic Ex Vivo Lung Perfusion: Effects on Clinical Outcomes', Transplantation. https://doi.org/10.1097/TP.0000000000000929
Terragni, Pier Paolo ; Fanelli, Vito ; Boffini, Massimo ; Filippini, Claudia ; Cappello, Paola ; Ricci, Davide ; Del Sorbo, Lorenzo ; Faggiano, Chiara ; Brazzi, Luca ; Frati, Giacomo ; Venuta, Federico ; Mascia, Luciana ; Rinaldi, Mauro ; Ranieri, V. M. / Ventilatory Management During Normothermic Ex Vivo Lung Perfusion : Effects on Clinical Outcomes. In: Transplantation. 2015.
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AU - Terragni, Pier Paolo

AU - Fanelli, Vito

AU - Boffini, Massimo

AU - Filippini, Claudia

AU - Cappello, Paola

AU - Ricci, Davide

AU - Del Sorbo, Lorenzo

AU - Faggiano, Chiara

AU - Brazzi, Luca

AU - Frati, Giacomo

AU - Venuta, Federico

AU - Mascia, Luciana

AU - Rinaldi, Mauro

AU - Ranieri, V. M.

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N2 - BACKGROUND: During ex vivo lung perfusion (EVLP), fixed ventilator settings and monitoring of compliance are used to prevent ventilator-induced lung injury (VILI). Analysis of the airway pressure-time curve (stress index) has been proposed to assess the presence of VILI. We tested whether currently proposed ventilator settings expose lungs to VILI during EVLP and whether the stress index could identify VILI better than compliance. METHODS: Flow, volume, and airway opening pressure were collected continuously during EVLP. Durations of mechanical ventilation, intensive care unit (ICU) and hospital lengths of stay were recorded in lung recipients. RESULTS: Fourteen lungs underwent EVLP and were transplanted. In 5 lungs, 95 ± 2% of the stress index values were within the 0.95 to 1.05 range (protected); in the remaining nine lungs, 69 ± 1% of the values were greater than 1.05 and 15 ± 3% were less than 0.95 (nonprotected). There was a significant (P <0.05) increase in cytokine concentrations after 4 hours of EVLP in the nonprotected lungs. Durations of mechanical ventilation, ICU, and hospital lengths of stay were shorter in recipients of protected than that of nonprotected lungs (P <0.05). There was no correlation between compliance during EVLP and duration of mechanical ventilation or ICU and hospital lengths of stay in recipients, but the stress index during EVLP was significantly correlated with the duration of mechanical ventilation and with ICU and hospital lengths of stay (P <0.05). CONCLUSIONS: This small, preliminary study shows that ventilator settings currently proposed for EVLP may expose lungs to VILI. Use of the stress index to personalize ventilator settings needs to be tested in further clinical studies.

AB - BACKGROUND: During ex vivo lung perfusion (EVLP), fixed ventilator settings and monitoring of compliance are used to prevent ventilator-induced lung injury (VILI). Analysis of the airway pressure-time curve (stress index) has been proposed to assess the presence of VILI. We tested whether currently proposed ventilator settings expose lungs to VILI during EVLP and whether the stress index could identify VILI better than compliance. METHODS: Flow, volume, and airway opening pressure were collected continuously during EVLP. Durations of mechanical ventilation, intensive care unit (ICU) and hospital lengths of stay were recorded in lung recipients. RESULTS: Fourteen lungs underwent EVLP and were transplanted. In 5 lungs, 95 ± 2% of the stress index values were within the 0.95 to 1.05 range (protected); in the remaining nine lungs, 69 ± 1% of the values were greater than 1.05 and 15 ± 3% were less than 0.95 (nonprotected). There was a significant (P <0.05) increase in cytokine concentrations after 4 hours of EVLP in the nonprotected lungs. Durations of mechanical ventilation, ICU, and hospital lengths of stay were shorter in recipients of protected than that of nonprotected lungs (P <0.05). There was no correlation between compliance during EVLP and duration of mechanical ventilation or ICU and hospital lengths of stay in recipients, but the stress index during EVLP was significantly correlated with the duration of mechanical ventilation and with ICU and hospital lengths of stay (P <0.05). CONCLUSIONS: This small, preliminary study shows that ventilator settings currently proposed for EVLP may expose lungs to VILI. Use of the stress index to personalize ventilator settings needs to be tested in further clinical studies.

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