Preserving donor lung

Q: While inflating donor lungs with oxygen, all of the following are true except?

A) It preserves the integrity of pulmonary surfactant
B) It improves the epithelial fluid transport 
C) Lung inflation is limited to an airway pressure of 20 cm H2O
D) Inflation should be done with 100% FiO2
E) Trachea should be clamped after inflation


Answer: D

Inflation of lungs with oxygen during the ischemic time protects the lungs. All of the choices are correct except it requires only 30-50% of FiO2. In fact, 100% FiO2 can be injurious due to oxygen toxicity.


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References:

1. DeCampos KN, Keshavjee S, Liu M, Slutsky AS. Optimal inflation volume for hypothermic preservation of rat lungs. J Heart Lung Transplant 1998; 17:599. 

2. Kayano K, Toda K, Naka Y, Pinsky DJ. Identification of optimal conditions for lung graft storage with Euro-Collins solution by use of a rat orthotopic lung transplant model. Circulation 1999; 100:II257.

3.  Eberlein M, Reed RM, Permutt S, et al. Parameters of donor-recipient size mismatch and survival after bilateral lung transplantation. J Heart Lung Transplant 2012; 31:1207.