Ischemic Preconditioning and Lung Preservation
Postoperative lung complications, arising from lung injury, occur during conventional cardiac surgery and during transplantation of the lung; both these procedures involve cardiopulmonary bypass (CPB). Lung injury is associated with various pathophysiological events that occur during CPB or the long-term storage of lungs during preservation. These events include ischemiareperfusion (I/R)/hypoxia-reoxygenation, inflammation, and generation of reactive oxygen species (ROS). To counteract these adverse pathophysiological effects, there are a number of techniques currently in use to protect the lung during cardiac surgery and lung transplantation. These include the use of continuous inflation or ventilation, various protective or preservation solutions, together with the potential for exploiting the endogenous protective mechanism of preconditioning.
This chapter briefly reviews the causes and mechanisms of lung injury and the techniques introduced to ameliorate this injury but focuses predominantly on the current evidence for preconditioning protection of the lung, including methods of initiating preconditioning in the lung (with emphasis on potentially clinically relevant triggers) to improve lung protection or preservation.