Which of the following pathophysiologic changes may occur in association with brain death and be harmful to the lungs from an organ donor? I. deactivation of pulmonary surfactant II. increased capillary permeability III. cytokine pulmonary-mediated pro-inflammatory response IV. activation of pulmonary fibroblasts
A. I, IV only
B. II, III only
C. I, II, III only
D. II, III, IV only
ANS: B
A. Incorrect response: See explanation B.
B. Correct response: The process of brain death can lead to a cascade of physiologic events that may be harmful to potential donor lungs. Initially, brain death causes excessive sympathetic stimulation that may lead to increased pulmonary capillary permeability. Combined with aggressive volume resuscitation, this predisposes the donor's lungs to pulmonary edema. Brain death is also accompanied by a cytokine–mediated pro-inflammatory response, which further contributes to pulmonary edema and acute lung injury. Potential donors frequently have associated pulmonary complications, including aspiration, neurogenic pulmonary edema, pneumonia, or pulmonary trauma.
C. Incorrect response: See explanation B.
D. Incorrect response: See explanation B.?
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