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Lung reconditioning with Steen solution vs ® albumin perfusion lung model in vivo

Grant number: 14/14436-8
Support type:Regular Research Grants
Duration: November 01, 2014 - January 31, 2017
Field of knowledge:Health Sciences - Medicine
Principal Investigator:Karina Andrighetti de Oliveira Braga
Grantee:Karina Andrighetti de Oliveira Braga
Home Institution: Instituto do Coração Professor Euryclides de Jesus Zerbini (INCOR). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
Assoc. researchers:Marcos Naoyuki Samano ; Paulo Manuel Pêgo-Fernandes

Abstract

According to data obtained in HCFMUSP - OPO ( Organ Procurement Organization , Faculty of Medicine, University of São Paulo ) , most of the lungs not used for transplantation is rejected based on blood gas results ( PO2 < 200 cm H2O with FiO2 100 % and 5 cmH2O PEEP ) .The great difficulty in maintaining potential donors is their hemodynamic stabilization , avoiding the sometimes irreparable damage to organs to be transplanted . Persistent hypotension triggers increased disorder ventilation / perfusion ( V / Q ) and intraparenchymal lung arising Shunt : alveolar edema with hyaline membrane with micro-atelectasis and alveolar collapse .The success of recondition lungs , increasing its ability to exchange gases , due to mobilization of alveolar and interstitial edema due to post hypoperfusion Brain Death . Some solutions to preserve tissues and organs containing human albumin and dextran , with high coloidosmótico power, leading to reduction of the edema . Lung preservation solutions available aim to reduce the incidence of ischemia - reperfusion and thus prevent the occurrence of primary graft dysfunction .Observing practices applied in acquiring other agencies , found that conduct is established , as in the case of the pancreas , the intravenous administration of 20% human albumin for intraoperative reduction of tissue edema and preparation of the recipient for graft reperfusion , preventing bankruptcy primary graft .One of the solutions with high power coloidosmótico used in the reconditioning of the lungs , is the Steen Solution ® . This is a commercial compound with high colloid osmotic pressure gradient in normothermia ( Steen Solution ® ) . The Steen ® Solution is a buffer solution , extracellular -type ( ie, low potassium concentration and high sodium concentration ) containing dextran and albumin. It is known that low potassium concentration is less harmful to the structural and functional integrity of the endothelial cells , which may lead to decreased production of oxidants and vasoconstrictive . Dextran is a macromolecule which increases the oncotic pressure and improves the deformability of erythrocytes , erythrocyte aggregation and preventing breakdown induced in red blood cells already aggregated. These effects contribute to improving lung microcirculation and preserve endothelium - epithelium interface. Albumin has the function , along with dextran , to maintain a high colloid osmotic pressure gradient , in order to avoid the development of pulmonary edema during reconditioning .Numerous experimental studies involving the use of hypertonic saline solutions and coloidosmóticas as albumin or dextran , models subjected to various insults such as hemorrhagic shock , multiple organ trauma , hypoxia or brain death and subsequent resuscitation demonstrated positive effects on perfusion of organs and tissues, including immunomodulation of the inflammatory response .When considering the ability , small volume infusion restoring mean arterial pressure and microvascular perfusion is renewed interest in using hypertonic solution , with or without dextran , a substance of high molecular weight and high colloid osmotic pressure taking effect beneficial in the pulmonary microcirculation , it improves the deformability of red blood cells , prevents the aggregation of red blood cells and platelets and has antithrombotic effect . A standard 4 ml.kg solution of 20% albumin infusion increases the plasma volume infused in 2-4 times the volume of water due to the mobilization of intracellular compartment.To assess these effects and the results applied to the reconditioning of lungs previously submitted to hemorrhagic shock , we developed a research project using intravenous administration of human albumin 20% solution developed for lung perfusion containing albumin and dextran ( Steen Solution , Vitrolife , Sweden). (AU)