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. 2017 Mar/Apr;63(2):216-222.
doi: 10.1097/MAT.0000000000000463.

Development of a Model of Pediatric Lung Failure Pathophysiology

John M Trahanas  1 , Fares Alghanem, Catalina Ceballos-Muriel, Hayley R Hoffman, Alice Xu, Kristopher B Deatrick, Marie S Cornell, Alvaro Rojas-Pena, Robert H Bartlett, Ronald B Hirschl
Affiliations

Development of a Model of Pediatric Lung Failure Pathophysiology

John M Trahanas et al. ASAIO J. 2017 Mar/Apr.

Abstract

A pediatric artificial lung (PAL) is under development as a bridge to transplantation or lung remodeling for children with end-stage lung failure (ESLF). To evaluate the efficiency of a PAL, a disease model mimicking the physiologic derangements of pediatric ESLF is needed. Our previous right pulmonary artery (rPA) ligation model (rPA-LM) achieved that goal, but caused immediate mortality in nearly half of the animals. In this study, we evaluated a new technique of gradual postoperative right pulmonary artery occlusion using a Rummel tourniquet (rPA-RT) in seven (25-40 kg) sheep. This technique created a stable model of ESLF pathophysiology, characterized by high alveolar dead space (58.0% ± 3.8%), pulmonary hypertension (38.4 ± 2.2 mm Hg), tachypnea (79 ± 20 breaths per minute), and intermittent supplemental oxygen requirement. This improvement to our technique provides the necessary physiologic derangements for testing a PAL, whereas avoiding the problem of high immediate perioperative mortality.

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Conflict of interest statement

Conflict of Interests: The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Intraoperative values obtained pre and post-occlusion while anesthetized and mechanically ventilated for A) Dead space ventilation fraction and B) PaCO2
Figure 2
Figure 2. Kaplan-Meier survival curves
Compared to the rPA-LM group, survival was significantly higher at both day 1 (p<0.001) and day 7 (p=0.005) in the rPA-RT group.
Figure 3
Figure 3. Hemodynamics plotted over time
A) Mean arterial blood pressure (PART); B) Mean pulmonary artery pressure (PPA); C) Mixed venous oxygen saturation; D) Cardiac output plotted over time. Values are expressed as means ± SD. “*” denotes a significant change from intraoperative baseline in the acute ligation model. “**” denotes a significant change from postoperative baseline in the Rummel tourniquet model.
Figure 4
Figure 4. Respiratory Effects plotted over time
A) Respiratory rate; B) PaCO2; C) PaO2; D) Average maximum daily oxygen requirement. Values are expressed as means ± SD. “**” denotes a significant change from postoperative baseline in the Rummel tourniquet model. These variable cannot be assessed under mechanical ventilation, thus no analysis was performed for the rPA-LM model.
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