A Porcine Model of Acute Lung Injury by Instillation of Gastric Fluid

• Published in: The Journal of surgical research 2011-04, Vol.166 (2), p.e195-e204
• Main Authors: Meers, Caroline M., D.V.M, De Wever, Walter, M.D., Ph.D, Verbeken, Eric, M.D., Ph.D, Mertens, Veerle, M.Sc, Wauters, Shana, M.Sc, De Vleeschauwer, Stéphanie I., D.V.M, Vos, Robin, M.D, Vanaudenaerde, Bart M., Ph.D, Verleden, Geert M., M.D., Ph.D, Van Raemdonck, Dirk E.M., M.D., Ph.D
• Format: Article
• Language: English
• Subjects: Acute Lung Injury - diagnostic imaging; Acute Lung Injury - pathology; Acute Lung Injury - physiopathology; Airway Resistance; Animals; Bronchoalveolar Lavage; Bronchoalveolar Lavage Fluid; Disease Models, Animal; gastric aspiration; Gastric Juice; lung donor shortage; Lung Transplantation; Male; Pneumonia - diagnostic imaging; Pneumonia - pathology; Pneumonia - physiopathology; Pulmonary Circulation; Pulmonary Gas Exchange; Radiography; Respiratory Aspiration - diagnostic imaging; Respiratory Aspiration - pathology; Respiratory Aspiration - physiopathology; Specific Pathogen-Free Organisms; Surgery; Swine; Tissue Donors
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2010.10.015

Background About 15% of donor lungs are declined because of aspiration contributing to current organ shortage. The aim was to develop a porcine lung injury model by gastric juice (GJ) instillation to study different pretransplant treatment strategies. Materials and Methods Pigs ( n = 6/group) were anesthetized and monitored. At T0 bronchoalveolar lavage (BAL) was performed followed by instillation of 4 mL/kg GJ or saline solution (SAL). Hemodynamics, aerodynamics and oxygenation were recorded for two hours. Serum samples were collected. At T120 a second BAL was performed. CT scans of explanted, inflated lungs were taken, tissue samples were collected and wet/dry weight ratio (W/D) was calculated. Pepsin and bile acids were measured in BAL. IL-8, CRP and MMP-9 were measured in serum and in BAL. Result Oxygenation and lung compliance was lower in [GJ] versus [SAL] ( P < 0.01 and P < 0.001, respectively). More consolidation areas were noticed on CT in GJ versus SAL ( P < 0.01). Hemorrhage, edema and neutrophil inflammation were seen on histology in [GJ] ( P  < 0.01, P < 0.001, P < 0.001, respectively). BAL neutrophils, pepsin, bile acids, and IL-8 ( P < 0.05) increased in [GJ]. W/D was higher in [GJ] versus SAL ( P < 0.001). Conclusion Instillation of GJ in pig lungs caused acute lung injury with impaired oxygenation and increased inflammation in BAL, on histology, and on imaging. This model holds promise to assess the efficacy of a broad range of treatment strategies including ex vivo lung perfusion (EVLP).