Background: Evaluation of donor lung function relies on the arterial oxygen partial pressure to inspired oxygen fraction ratio (PaO2/FiO2) measurement. Hemodynamic, metabolic derangements, and therapeutic intervention occurring during brain dead observation may influence the evaluation of gas exchange. Methods: We performed a mathematical analysis to explore the influence of the extrapulmonary determinants on the interpretation of PaO2/FiO2 in the brain-dead donor and during Ex-Vivo Lung Perfusion (EVLP). Results: High FiO2 and increased mixed venous oxygen saturation, caused by increased delivery and reduced consumption of oxygen, raise the PaO2/FiO2 despite substantial intrapulmonary shunt. Anemia does not modify the PaO2/FiO2—intrapulmonary shunt relationship. During EVLP, the reduced artero-venous difference in oxygen content increases the PaO2/FiO2 without this corresponding to an optimal graft function, while the reduced perfusate oxygen-carrying capacity linearizes the PaO2/FiO2—intrapulmonary shunt relationship. Conclusions: Adopting PaO2/FiO2 to evaluate graft suitability for transplantation should account for extrapulmonary factors affecting its interpretation.

Limitations of arterial partial pressure of oxygen to fraction of inspired oxygen ratio for the evaluation of donor lung function / J. Fumagalli, S.M. Colombo, V. Scaravilli, F. Gori, A. Pesenti, A. Zanella, G. Grasselli. - In: ARTIFICIAL ORGANS. - ISSN 0160-564X. - 46:11(2022), pp. 2313-2318. [10.1111/aor.14350]

Limitations of arterial partial pressure of oxygen to fraction of inspired oxygen ratio for the evaluation of donor lung function

S.M. Colombo
Secondo
;
V. Scaravilli;A. Pesenti;A. Zanella
Penultimo
;
G. Grasselli
Ultimo
2022

Abstract

Background: Evaluation of donor lung function relies on the arterial oxygen partial pressure to inspired oxygen fraction ratio (PaO2/FiO2) measurement. Hemodynamic, metabolic derangements, and therapeutic intervention occurring during brain dead observation may influence the evaluation of gas exchange. Methods: We performed a mathematical analysis to explore the influence of the extrapulmonary determinants on the interpretation of PaO2/FiO2 in the brain-dead donor and during Ex-Vivo Lung Perfusion (EVLP). Results: High FiO2 and increased mixed venous oxygen saturation, caused by increased delivery and reduced consumption of oxygen, raise the PaO2/FiO2 despite substantial intrapulmonary shunt. Anemia does not modify the PaO2/FiO2—intrapulmonary shunt relationship. During EVLP, the reduced artero-venous difference in oxygen content increases the PaO2/FiO2 without this corresponding to an optimal graft function, while the reduced perfusate oxygen-carrying capacity linearizes the PaO2/FiO2—intrapulmonary shunt relationship. Conclusions: Adopting PaO2/FiO2 to evaluate graft suitability for transplantation should account for extrapulmonary factors affecting its interpretation.
ex vivo lung perfusion; intrapulmonary shunt; lung transplantation; mixed venous oxygen saturation; multiorgan donor; Partial Pressure; Blood Gas Analysis; Lung; Oxygen; Pulmonary Gas Exchange
Settore MED/41 - Anestesiologia
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/944828
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