Improvement of gas exchange, pulmonary function, and lung injury with partial liquid ventilation. A study model in a setting of severe respiratory failure.

STUDY OBJECTIVE To evaluate gas exchange, pulmonary function, and lung histology during gas ventilation of the perfluorocarbon-filled lung compared with gas ventilation of the gas-filled lung in severe respiratory failure. STUDY DESIGN Application of gas (GV) or partial liquid (PLV) ventilation in lung-injured sheep. SETTING A research laboratory at a university medical center. SUBJECTS Eleven sheep 17.1 +/- 1.8 kg in weight. INTERVENTIONS Lung injury was induced by intravenous administration of 0.07 mL/kg oleic acid followed by saline pulmonary lavage. When alveolar-arterial oxygen pressure difference (P[A-a]O2) was 600 mm Hg or more and PaO2 was 50 mm Hg or less with fraction of inspired oxygen of 1.0, bijugular venovenous extracorporeal life support (ECLS) was instituted. For the first 30 min on ECLS, all animals were ventilated with gas. Over the ensuing 2.5 h, ventilation with 15 mL/kg gas was continued without intervention in the control group (GV, n = 6) or with the addition of 35 mL/kg of perflubron (PLV, n = 5). MEASUREMENTS AND RESULTS At 3 h after initiation of ECLS, Qps/Qt was significantly reduced in the PLV animals when compared with the GV animals (PLV = 41 +/- 13%; GV = 93 +/- 4%; p < 0.005). At the same time point, pulmonary compliance was increased in the PLV when compared with the GV group (PLV = 0.61 +/- 0.14 mL/cm H2O/kg; GV = 0.41 +/- 0.02 mL/cm H2O/kg; p < 0.005). The ECLS flow rate required to maintain the PaO2 in the 50 to 80 mm Hg range was substantially and significantly lower in the PLV group when compared with that of the GV group (PLV = 25 +/- 20 mL/kg/min; GV = 87 +/- 15 mL/kg/min; p < 0.001). Light microscopy performed on lung biopsy specimens demonstrated a marked reduction in lung injury in the liquid ventilated (LV) when compared with the GV animals. CONCLUSION In a model of severe respiratory failure, PLV improves pulmonary gas exchange and pulmonary function and is associated with a reduction in pulmonary pathology.

[1]  G. Carlon,et al.  High-Frequency Jet Ventilation: A Prospective Randomized Evaluation , 1983 .

[2]  H. Schellekens,et al.  Neonatal Host Defense Mechanisms against Listeria monocytogenes Infection: The Role of Lipopolysaccharides and Interferons , 1989, Pediatric Research.

[3]  Bartlett Rh,et al.  Extracorporeal membrane oxygenation support in cardiorespiratory failure. , 1988, Advances in surgery.

[4]  M R Wolfson,et al.  Comparison of gas and liquid ventilation: clinical, physiological, and histological correlates. , 1992, Journal of applied physiology.

[5]  P. Dandona,et al.  PERFLUBRON (PFB) DECREASES FREE RADICAL (FR) PRODUCTION BY ALVEOLAR MACROPHAGES (AM) IN VITRO , 1994 .

[6]  R. Kacmarek,et al.  Ventilatory strategies in the management of the adult respiratory distress syndrome. , 1990, Clinics in chest medicine.

[7]  Wolfson Mr,et al.  Liquid ventilation during early development: theory, physiologic processes and application. , 1990 .

[8]  C. Derks,et al.  Embolic pneumopathy induced by oleic acid. A systematic morphologic study. , 1977, The American journal of pathology.

[9]  N. S. Faithfull,et al.  Comparison of ventilatory support with intratracheal perfluorocarbon administration and conventional mechanical ventilation in animals with acute respiratory failure. , 1993, The American review of respiratory disease.

[10]  R. Bartlett,et al.  Extracorporeal Life Support Organization 1994. , 1994, ASAIO journal.

[11]  Demling Rh.  Current concepts on the adult respiratory distress syndrome. , 1990 .

[12]  W H Schoenfisch,et al.  Maximum expiratory flow and estimated CO 2 elimination in liquid-ventilated dogs' lungs. , 1973, Journal of applied physiology.

[13]  T. Shaffer,et al.  Liquid ventilation: cardiovascular adjustments with secondary hyperlactatemia and acidosis. , 1979, Journal of applied physiology: respiratory, environmental and exercise physiology.

[14]  G. Moskowitz,et al.  Pulmonary Lavage in Preterm Lambs , 1978, Pediatric Research.

[15]  J. Crapo,et al.  Pulmonary morphology in a multihospital collaborative extracorporeal membrane oxygenation project. I. Light microscopy. , 1979, The American journal of pathology.

[16]  J. Kylstra,et al.  Alveolar surface tension in fluorocarbon-filled lungs. , 1972, Journal of applied physiology.

[17]  A. Pesenti,et al.  Pressure-volume curve of total respiratory system in acute respiratory failure. Computed tomographic scan study. , 1987, The American review of respiratory disease.

[18]  T. Shaffer,et al.  Liquid ventilation of human preterm neonates. , 1990, The Journal of pediatrics.

[19]  E. Motoyama,et al.  Cardiac output during liquid (perfluorocarbon) breathing in newborn piglets , 1991, Critical care medicine.

[20]  Hickling Kg,et al.  Low volume ventilation with permissive hypercapnia in the Adult Respiratory Distress Syndrome. , 1992 .

[21]  Thomas H Shaffer,et al.  Fluorocarbon Ventilation: Maximal Expiratory Flows and CO2 Elimination , 1988, Pediatric Research.

[22]  P. Richman,et al.  Lung lavage with oxygenated perfluorochemical liquid in acute lung injury , 1993, Critical care medicine.

[23]  J. Modell,et al.  Residual levels and biochemical changes after ventilation with perfluorinated liquid. , 1975, Journal of applied physiology.

[24]  G D Moskowitz,et al.  Demand-controlled liquid ventilation of the lungs. , 1974, Journal of applied physiology.

[25]  N. S. Faithfull,et al.  Intratracheal perfluorocarbon administration combined with mechanical ventilation in experimental respiratory distress syndrome: Dose‐dependent improvement of gas exchange , 1993, Critical care medicine.

[26]  F. Gollan,et al.  Survival of Mammals Breathing Organic Liquids Equilibrated with Oxygen at Atmospheric Pressure , 1966, Science.

[27]  J. Modell,et al.  Pulmonary Lavage with Liquid Fluorocarbon in a Model of Pulmonary Edema , 1973, Anesthesiology.

[28]  J. Modell,et al.  Long-term survival of dogs after breathing oxygenated fluorocarbon liquid. , 1970, Federation proceedings.

[29]  B. Yates,et al.  Survival and histopathologic changes in lungs of hamsters following synthetic liquid breathing. , 1970, Federation proceedings.

[30]  B. Fuhrman,et al.  Perfluorocarbon‐associated gas exchange (partial liquid ventilation) in respiratory distress syndrome A prospective, randomized, controlled study , 1993, Critical care medicine.

[31]  L. Duffy,et al.  Perfluorocarbon-associated gas exchange in gastric aspiration , 1993 .

[32]  R. Rufer,et al.  Liquid ventilation in the respiratory distress syndrome. , 1974, Chest.

[33]  S. Curtis,et al.  Partial liquid breathing with perflubron improves arterial oxygenation in acute canine lung injury. , 1993, Journal of applied physiology.

[34]  P. Pelosi,et al.  Regional effects and mechanism of positive end-expiratory pressure in early adult respiratory distress syndrome. , 1993, JAMA.

[35]  J. Modell,et al.  Distribution and retention of fluorocarbon in mice and dogs after injection or liquid ventilation. , 1973, Toxicology and applied pharmacology.

[36]  R. Bartlett,et al.  Liquid ventilation provides uniform distribution of perfluorocarbon in the setting of respiratory failure. , 1994, Surgery.

[37]  L. Fink,et al.  Effect of perfluorochemical blood substitutes on human neutrophil function , 1984, Transfusion.

[38]  B Lachmann,et al.  In Vivo Lung Lavage as an Experimental Model of the Respiratory Distress Syndrome , 1980, Acta anaesthesiologica Scandinavica.

[39]  B. Robertson,et al.  Liquid ventilation in immature newborn rabbits. , 1976, Biology of the neonate.

[40]  T. Albertson,et al.  Pressure controlled inverse ratio ventilation in severe adult respiratory failure. , 1988, Chest.

[41]  M R Wolfson,et al.  Liquid Ventilation Improves Pulmonary Function, Gas Exchange, and Lung Injury in a Model of Respiratory Failure , 1995, Annals of surgery.

[42]  R. Bartlett,et al.  A prospective study of acute hypoxic respiratory failure. , 1986, Chest.

[43]  S. Matalon,et al.  Role of Pulmonary Surfactant in the Development and Treatment of Adult Respiratory Distress Syndrome , 1989, Anesthesia and analgesia.

[44]  D. Parker,et al.  Effect of fluorocarbon liquid on surface tension properties of pulmonary surfactant. , 1970, Chest.

[45]  Sargent Jw,et al.  Properties of perfluorinated liquids. , 1970 .

[46]  J. Modell,et al.  Uptake, Distribution, and Excretion of Fluorocarbon FX‐80 (Perfluorobutyl Perfluorotetrahydrofuran) during Liquid Breathing in the Dog , 1972, Anesthesiology.

[47]  E. W. Swenson,et al.  Pulmonary Function after Ventilation with Fluorocarbon Liquid (Caroxin‐D) , 1973, Anesthesiology.

[48]  J. Kylstra,et al.  Of mice as fish. , 1962, Transactions - American Society for Artificial Internal Organs.

[49]  P. Pepe,et al.  Early application of positive end-expiratory pressure in patients at risk for the adult respiratory-distress syndrome. , 1984, The New England journal of medicine.