Extended high-frequency partial liquid ventilation in lung injury: gas exchange, injury quantification, and vapor loss

2003 ◽  
Vol 95 (3) ◽  
pp. 1248-1258 ◽  
Author(s):  
Allan Doctor ◽  
Eman Al-Khadra ◽  
Puay Tan ◽  
Kenneth F. Watson ◽  
Diana L. Diesen ◽  
...  
Keyword(s):  
Gas Exchange ◽  
Lung Injury ◽  
High Frequency ◽  
Oxygenation Index ◽  
High Frequency Oscillatory Ventilation ◽  
Partial Liquid Ventilation ◽  
Dependent Lung ◽  
Liquid Ventilation ◽  
Evaporative Loss ◽  
High Frequency Oscillatory

High-frequency oscillatory ventilation with perflubron (PFB) reportedly improves pulmonary mechanics and gas exchange and attenuates lung injury. We explored PFB evaporative loss kinetics, intrapulmonary PFB distribution, and dosing strategies during 15 h of high-frequency oscillation (HFO)-partial liquid ventilation (PLV). After saline lavage lung injury, 15 swine were rescued with high-frequency oscillatory ventilation ( n = 5), or in addition received 10 ml/kg PFB delivered to dependent lung [ n = 5, PLV-compartmented (PLV(C))] or 10 ml/kg distributed uniformly within the lung [ n = 5, PLV(U)]. In the PLV(C) group, PFB vapor loss was replaced. ANOVA revealed an unsustained improvement in oxygenation index in the PLV(U) group ( P = 0.04); the reduction in oxygenation index correlated with PFB losses. Although tissue myeloperoxidase activity was reduced globally by HFO-PLV ( P < 0.01) and regional lung injury scores (lung injury scores) in dependent lung were improved ( P = 0.05), global lung injury scores were improved by HFO-PLV ( P < 0.05) only in atelectasis, edema, and alveolar distension but not in cumulative score. In our model, markers of inflammation and lung injury were attenuated by HFO-PLV, and it appears that uniform intrapulmonary PFB distribution optimized gas exchange during HFO-PLV; additionally, monitoring PFB evaporative loss appears necessary to stabilize intrapulmonary PFB volume.

Continuous tracheal gas insufflation during partial liquid ventilation in juvenile rabbits with acute lung injury

2004 ◽  
Vol 96 (4) ◽  
pp. 1415-1424 ◽  
Author(s):  
Guangfa Zhu ◽  
Thomas H. Shaffer ◽  
Marla R. Wolfson
Keyword(s):  
Acute Lung Injury ◽  
Gas Exchange ◽  
Lung Injury ◽  
Combined Treatment ◽  
Peak Inspiratory Pressure ◽  
Oxygenation Index ◽  
Lung Mechanics ◽  
Partial Liquid Ventilation ◽  
Liquid Ventilation ◽  
Tracheal Gas Insufflation

To examine the hypothesis that combined treatment with tracheal gas insufflation (TGI) and partial liquid ventilation (PLV) may improve pulmonary outcome relative to either treatment alone in acute lung injury (ALI), saline lavage lung injury was induced in 24 anesthetized, ventilated juvenile rabbits that were then randomly assigned to receive ( n = 6/group) 1) conventional mechanical ventilation (CMV) alone, 2) continuous TGI at 0.5 l/min, 3) PLV with perfluorochemical liquid, and 4) combined TGI and PLV (TGI + PLV), and subsequently ventilated with minimized pressures and tidal volume (Vt) to keep arterial Po2 (PaO2) >100 Torr and arterial Pco2 (PaCO2) at 45-60 Torr for 4 h. Gas exchange, lung mechanics, myeloperoxidase, IL-8, and histomorphometry [including expansion index (EI)] were assessed. The CMV group showed no improvement in lung mechanics and gas exchange; all treated groups had significant increases in compliance, PaO2, ventilation efficacy index (VEI), and EI, and decreases in PaCO2, oxygenation index, physiological dead space-to-Vt ratio (Vd/Vt), myeloperoxidase, and IL-8, relative to the CMV group. TGI resulted in lower peak inspiratory pressure, Vt, Vd/Vt, and greater VEI vs. PLV group; PLV resulted in greater compliance, PaO2, and EI vs. TGI. TGI + PLV resulted in decreased peak inspiratory pressure, Vt, Vd/Vt, and increased VEI compared with TGI, improved compliance and EI compared with PLV, and a further increase in PaO2 and oxygenation index and a decrease in PaCO2 vs. either treatment alone. These results indicate that combined treatment of TGI and PLV results in improved pulmonary outcome than either treatment alone in this animal model of ALI.

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