[The lung in brain death. Anatomo-biological correlations for pulmonary transplantation]

Histopathological studies of the lung conducted during multiple organ procurement from 25 subjects in a state of brain death showed that 19 of them had lung lesions pre-existent to coma, viz. alveolitis and lung invasion by dusts increasing with the subject's age. Alveolar or interstitial emphysema and subpleural bullae caused by mechanical ventilation were present in 19 cases; signs of bronchial inertia were found in 6 cases and established superinfection in 3 cases. Finally, 17 subjects showed interstitial and vascular alterations induced by oedema and shock which were related to the time spent in intensive care units, to the cause of the coma and to the quantity and quality of intravenous received while in intensive care unit. There were histological correlations between these various factors, but precise criteria concerning the functional prognosis of the transplant could not be defined. However, this study seemed to confirm the need for a new approach to the intensive care of brain-dead subjects during lung procurement: the time elapsed before procurement should be shortened, the amount of medicinal solutions administered should be reduced, Ringer lactate and packed cells should be used in preference to albumin derivatives, and arterial blood pressure, rather than diuresis, should be maintained.