Isolated Lung Perfusion in the Management of Acute Respiratory Distress Syndrome

Int J Mol Sci. 2020 Sep 17;21(18):6820. doi: 10.3390/ijms21186820.

Abstract

Acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality, and current management has a dramatic impact on healthcare resource utilization. While our understanding of this disease has improved, the majority of treatment strategies remain supportive in nature and are associated with continued poor outcomes. There is a dramatic need for the development and breakthrough of new methods for the treatment of ARDS. Isolated machine lung perfusion is a promising surgical platform that has been associated with the rehabilitation of injured lungs and the induction of molecular and cellular changes in the lung, including upregulation of anti-inflammatory and regenerative pathways. Initially implemented in an ex vivo fashion to evaluate marginal donor lungs prior to transplantation, recent investigations of isolated lung perfusion have shifted in vivo and are focused on the management of ARDS. This review presents current tenants of ARDS management and isolated lung perfusion, with a focus on how ex vivo lung perfusion (EVLP) has paved the way for current investigations utilizing in vivo lung perfusion (IVLP) in the treatment of severe ARDS.

Keywords: acute lung injury; acute respiratory distress syndrome; inflammation; isolated lung perfusion; therapeutics.

Publication types

  • Historical Article
  • Review

MeSH terms

  • Animals
  • History, 19th Century
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Inflammation / physiopathology
  • Inflammation / therapy*
  • Lung Injury / physiopathology
  • Lung Injury / therapy*
  • Perfusion / history
  • Perfusion / instrumentation
  • Perfusion / methods*
  • Respiratory Distress Syndrome / diagnostic imaging
  • Respiratory Distress Syndrome / therapy*
  • Tissue Donors