Continuous Endogenous Exhaled CO Monitoring by Laser Spectrometer in Human EVLP Before Lung Transplantation
Résumé
Endogenous production of carbon monoxide (CO) is affected by inflammatory phenomena and ischemia-reperfusion injury. Precise measurement of exhaled endogenous CO (eCO) is possible thanks to a laser spectrometer (ProCeas® from AP2E company). We assessed eCO levels of human lung grafts during the normothermic Ex-Vivo Lung Perfusion (EVLP). ProCeas® was connected in bypass to the ventilation circuit. The surgical team took the decision to transplant the lungs without knowing eCO values. We compared eCO between accepted and rejected grafts. EVLP parameters and recipient outcomes were also compared with eCO values. Over 7 months, eCO was analyzed in 21 consecutive EVLP grafts. Two pairs of lungs were rejected by the surgical team. In these two cases, there was a tendency for higher eCO values (0.358 ± 0.52 ppm) compared to transplanted lungs (0.240 ± 0.76 ppm). During the EVLP procedure, eCO was correlated with glucose consumption and lactate production. However, there was no association of eCO neither with edema formation nor with the PO 2 /FiO 2 ratio per EVLP. Regarding post-operative data, every patient transplanted with grafts exhaling high eCO levels (>0.235 ppm) during EVLP presented a Primary Graft Dysfunction score of 3 within the 72 h post-transplantation. There was also a tendency for a longer stay in ICU for recipients with grafts exhaling high eCO levels during EVLP. eCO can be continuously monitored during EVLP. It could serve as an additional and early marker in the evaluation of the lung grafts providing relevant information for post-operative resuscitation care.
Mots clés
interleukine
ISHLT
International Society for Heart and Lung Transplantation
OF-CEAS
optical-Feedback cavity-enhanced absorption spectroscopy
PGD
primary graft dysfunction
ppm
parts per million
TNF
tumoral necrosis factor
carbon monoxide
cavity enhanced laser absorption spectroscopy
ex-vivo lung perfusion
gasotransmitters
ischemia-reperfusion
lung inflammation
lung transplant
spectroscopy
brain dead donors CO
carbon monoxide eCO
endogenous exhaled carbon monoxide DCD
donor after circulatory death ECMO
extra corporeal membrane oxygenation EVLP
ex-vivo lung perfusion HO
heme oxygenase IL
interleukine ISHLT
International Society for Heart and Lung Transplantation OF-CEAS
optical-Feedback cavity-enhanced absorption spectroscopy PGD
primary graft dysfunction ppm
parts per million TNF
ECMO
extra corporeal membrane oxygenation
EVLP
HO
heme oxygenase
IL
Origine : Fichiers éditeurs autorisés sur une archive ouverte
Licence : CC BY - Paternité
Licence : CC BY - Paternité