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J Thorac Cardiovasc Surg 2002;124:1137-1144
© 2002 The American Association for Thoracic Surgery

Cardiothoracic Transplantation (TX)

Effect of ventilator-induced lung injury on the development of reperfusion injury in a rat lung transplant model

From the Thoracic Surgery Research Laboratory,^a Toronto General Hospital, Respiratory Medicine and Critical Care,^b St Michael Hospital, Department of Pathology and Laboratory Medicine,^c Mount Sinai Hospital, Department of Anesthesia,^d Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada, and the Dipartimento di Discipline Medico-Chirurgiche,^e Sezione di Anestesiologia e Rianimazione, Università di Torino, Ospedale S. Giovanni Battista, Torino, Italy.

Received for publication Nov 8, 2001. Revisions requested Feb 5, 2002; revisions received March 11, 2002. Accepted for publication March 24, 2002. Address for reprints: S. Keshavjee, MD, Director, Thoracic Surgery Research Laboratory, Toronto General Hospital, 200 Elizabeth St, EN 10-224, Toronto, Ontario, Canada M5G 2C4 (E-mail: shaf.keshavjee{at}uhn.on.ca).

Objective: Although mechanical ventilation can potentially worsen preexisting lung injury, its importance in the setting of lung transplantation has not been explored. This study was undertaken to examine the effect of 2 ventilatory strategies on the development of ischemia-reperfusion injury after lung transplantation.
Methods: In a rat lung transplant model animals were randomized into 2 groups defined by the ventilatory strategy during the early reperfusion period. In conventional mechanical ventilation the transplanted lung was ventilated with a tidal volume equal to 50% of the inspiratory capacity of the left lung and a low positive end-expiratory pressure. In minimal mechanical stress ventilation the transplanted lung was ventilated with a tidal volume equal to 20% of the inspiratory capacity of the left lung, and positive end-expiratory pressure was adjusted according to the shape of the pressure-time curve to minimize pulmonary stress.
Results: After 3 hours of reperfusion, oxygenation from the transplanted lung was significantly higher with minimal mechanical stress ventilation than with conventional ventilation. In addition, elastance, cytokine levels, and morphologic signs of injury were significantly lower in the group with minimal mechanical stress ventilation.
Conclusions: This study demonstrates that the mode of mechanical ventilation used in the early phase of reperfusion of the transplanted lung can influence ischemia-reperfusion injury, and a protective ventilatory strategy on the basis of minimizing pulmonary mechanical stress can lead to improved lung function after lung transplantation.

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