ABSTRACT
Atelectasis and inadequate oxygenation in lung donors is a common problem during the retrieval of these organs. Nevertheless, the use of high positive end-expiratory pressure (PEEP) is not habitual during procedures of lung retrieval. Twenty-one Sprague-Dawley male consanguineous rats were used in the study. The animals were divided into 3 groups according to the level of PEEP used: low (2 cmH2O), moderate (5 cmH2O), and high (10 cmH2O). Animals were ventilated with a tidal volume of 6 mL/kg. Before lung removal, the lungs were inspected for the presence of atelectasis. When atelectasis was detected, alveolar recruitment maneuvers were performed. Blood gasometric analysis was performed immediately. Finally, the lungs were retrieved, weighed, and submitted to histological analysis. The animals submitted to higher PEEP showed higher levels of oxygenation with the same tidal volumes PO2=262.14 (PEEP 2), 382.4 (PEEP 5), and 477.0 (PEEP 10). The occurrence of atelectasis was rare in animals with a PEEP of 10 cmH2O, which therefore required less frequent recruitment maneuvers (need for recruitment: PEEP 2=100%, PEEP 5 =100%, and PEEP 10=14.3%). There was no change in hemodynamic stability, occurrence of pulmonary edema, or other histological injuries with the use of high PEEP. The use of high PEEP (10 cmH2O) was feasible and probably a beneficial strategy for the prevention of atelectasis and the optimization of oxygenation during lung retrieval. Clinical studies should be performed to confirm this hypothesis.
Subject(s)
Animals , Male , Rats , Pulmonary Atelectasis/rehabilitation , Pulmonary Gas Exchange/physiology , Tidal Volume/physiology , Positive-Pressure Respiration/methods , Lung Transplantation/methods , Pulmonary Atelectasis/physiopathology , Rats, Sprague-Dawley , Models, AnimalABSTRACT
Durante el período de Mayo de 1995 a Diciembre de 1995 se realizaron en la Clínica San Pablo - Instituto del Corazón de Lima - Perú 52 procedimientos broncofibroscópicos (BFF) en 26 pacientes de sexo masculino y 26 pacientes de sexo femenino, con una edad media de 61,74 (con un rango de 21-88 años) y 54,88 (con un rango de 7-74 años) respectivamente. El síntoma fundamental fue tos en 71,15 por ciento, asintomáticos respiratorios en 28,85 por ciento y sombra anormal en la radiografía de tórax en 42,31 por ciento. Por esta razón se realizaron 40 biopsias transbronquiales (76 por ciento) (TBLB) y lavado bronquioloalveolar en 13 pacientes (25 por ciento) (BAL), lográndose una efectividad diagnóstica de 88,46 por ciento (46 casos). Las complicaciones relacionadas a la biopsia transbronquial (TBLB) fueron de 3,85 por ciento (2 pacientes) que requirieron drenaje torácico y sangrado leve que cede con solución vasoconstrictora en 15,38 por ciento (8 pacientes). No hubo mortalidad.