Comparison of Ventilatory Support with Intratracheal Perfluorocarbon Administration and Conventional Mechanical Ventilation in Animals with Acute Respiratory Failure

Tütüncü, Ahmet; Faithfull, N. S.; Lachmann, Burkhard

doi:10.1164/ajrccm/148.3.785

Cited by 152 publications

(30 citation statements)

References 25 publications

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“…Metabolic acidosis during PLV has previously been reported in normocapnic animals, and has been attributed to changes in organ blood flow [9,15].…”

Section: Discussionmentioning

confidence: 87%

Partial liquid ventilation with small volumes of FC 3280 increases survival time in experimental ARDS

Kaisers¹,

Max²,

Walter³

et al. 1997

Eur Respir J

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The aim of this study was to determine the prolonged effects of sequential doses of a highly purified perfluorocarbon (FC 3280) on gas exchange and survival time in experimental acute respiratory distress syndrome (ARDS).The study was prospective, randomized and controlled. Twelve pigs (body weight 30±5 (mean±SD) kg) were surfactant-depleted by repetitive lung lavages, reducing arterial oxygen tension (Pa,O 2 ) to 6.9±1.6 kPa (52±12 mmHg) (mean±SD) at an inspired oxygen fraction (FI,O 2 ) of 1.0. They were then randomized to receive partial liquid ventilation by sequential intratracheal application of 7.5 mL·kg -1 FC 3280 at 30 min intervals to a cumulative dose of 15 mL·kg -1 (treatment group), or to receive no further treatment (control group). Haemodynamics and gas exchange were assessed at 30 min intervals after instillation, and hourly afterwards in both groups until death.In the treatment group, Pa,O 2 was 8.9±4.4 kPa (67±33 mmHg) after 7.5 mL·kg -1 FC 3280 and 14.1±9.9 kPa (106±74 mmHg) after 15 mL·kg -1 FC 3280 (NS). In the control group, gas exchange remained unchanged. Haemodynamics were stable in the treatment group and deteriorated in the control group. Peak airway pressures and dynamic compliance were not significantly affected in the treatment group. Mean survival time was 8.2±4.5 h in the treatment group and 1.8±1.4 h in the control group (p<0.05). Upon histological examination, both study groups were not significantly different in total lung injury scores.We conclude that partial liquid ventilation with small volumes of FC 3280 provides improvement in gas exchange and increases survival time in experimental acute respiratory distress syndrome. Eur Respir J 1997; 10: 1955-1961

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“…Metabolic acidosis during PLV has previously been reported in normocapnic animals, and has been attributed to changes in organ blood flow [9,15].…”

Section: Discussionmentioning

confidence: 87%

Partial liquid ventilation with small volumes of FC 3280 increases survival time in experimental ARDS

Kaisers¹,

Max²,

Walter³

et al. 1997

Eur Respir J

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“…Indeed, from some of these new concepts further benefit for patients with acute lung injury is expected (table 1). Others, such as liquid ventilation [80], are still experimental. A recent consensus conference [25] concluded that there are no convincing data that any ventilatory support mode is superior to others for ARDS patients.…”

Section: Tracheal Gas Insufflation (Tgi)mentioning

confidence: 99%

New strategies in mechanical ventilation for acute lung injury

Burchardi¹

1996

Eur Respir J

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In the fluid-filled lungs of early adult respiratory distress syndrome (ARDS) the dependent parts are compressed and atelectatic; whereas, the nondependent areas remain aerated and functional. Ventilating these considerably restricted lungs carries the risk of overinflation and ventilatory-induced lung injury (baro-volutrauma).The consequences for adjusting mechanical ventilation are: 1) reducing tidal volumes in order to avoid alveolar hyperinflation and excessive alveolar pressures; 2) considering permissive hypercapnia if adequate CO 2 elimination cannot be maintained; 3) keeping open the unstable alveoli by positive end-expiratory pressure (PEEP) (external or intrinsic). However, the large variations in regional lung compliance make it improbable that an optimal external PEEP level beneficial for the whole lung will be found; 4) using intrinsic PEEP in the inverse ratio ventilation (IRV) mode which varies with differences in regional ventilatory kinetics. No clinical study has yet convincingly demonstrated the benefit of IRV compared to conventional ventilation, controlled clinical long-term trials are not yet available; and 5) using superimposed spontaneous breathing which may be considerably more effective in opening up collapsed alveoli, combined with intentional intrinsic PEEP this is achieved in airway pressure release ventilation (APRV).Other new principles of mechanical ventilation, such as "proportional assist ventilation" or "tracheal gas insufflation" must still be considered as experimental. Eur Respir J., 1996Respir J., , 9, 1063 SERIES 'CLINICAL PHYSIOLOGY IN RESPIRATORY INTENSIVE CARE' Edited by A. Rossi and C. RoussosMechanical ventilation and ventilatory support techniques have undergone an impressive evolution within the last 10 yrs. This was due to considerable technical development rather than a radical change in our pathophysiological knowledge. Today, a variety of new techniques are available which facilitate new ventilatory strategies. In this review, only strategies for nonobstructive acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) will be presented and discussed. Strategies for chronic obstructive airways diseases (COPD) differ considerably; they will not be mentioned in this connection. Pathophysiological basisIn ALI and ARDS, (the American-European Consensus Conference on ARDS [1] changed the former expression "adult respiratory distress syndrome" into "acute respiratory distress syndrome", since ARDS is not limited to adults), the hallmark is a critical increase of pulmonary membrane permeability. This can happen by two different pathways: directly by lesion of lung cells; and indirectly as the result of an acute systemic inflammatory reaction (cellular and humoral effects). This results in a bilateral pulmonary interstitial and intra-alveolar (noncardiogenic) oedema.As a consequence, alveoli are compressed or flooded, and the surface for pulmonary gas exchange is considerably reduced by multiple atelectases. In this way, venous admixture and intr...

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“…Twelve New Zealand White juvenile rabbits (8 -10 wk old; weight, 1.3-2.1 kg) with normal lungs were anesthetized with an intramuscular injection of a mixture of ketamine (23 mg/kg), acepromazine (0.58 mg/kg), and xylazine (0.8 mg/kg) and an intramuscular injection of atropine (0.02 mg/kg) was given. This animal model was chosen based on our previous experience with the model, the suitability of the model as it applies to neonatal and pediatric medicine, and the history of this preparation for liquid ventilation (21)(22)(23)(24)(25). The skin and soft tissues were anesthetized with 0.5% lidocaine HCl (4 mg/kg), and the animals were instrumented with tracheostomy placement of a 3-mm-internal diameter endotracheal tube (Hi-Lo Jet Tube: Mallinkrodt, St. Louis, MO).…”

Section: Methodsmentioning

confidence: 99%

“…Also, we examined whether PFCmediated administration of rhSOD would enhance lung distribution of the enzyme and, in the short term, decrease markers of oxidative damage. Finally, physiologic and histologic comparisons of SOD treatment groups are discussed within the context of published data from untreated animals and those treated with PFC alone (21)(22)(23)(24)(25)(26)(27).…”

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confidence: 99%

Perfluorochemical Liquids Enhance Delivery of Superoxide Dismutase to the Lungs of Juvenile Rabbits

et al. 2006

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Previous studies suggest acute lung injury (ALI) in premature newborns is associated with relative deficiency of antioxidant enzymes that may be ameliorated by recombinant human superoxide dismutase (rhSOD). Perfluorochemicals (PFCs) are distributed homogeneously and support gas exchange in diseased lungs. We investigated whether PFCs could provide an effective delivery system for rhSOD. Juvenile rabbits were lung-lavaged, treated with surfactant, and randomized: group I: fluorescently labeled rhSOD (5 mg/kg in 2 mL/kg saline); group II: fluorescently labeled rhSOD (5 mg/kg in 18 mL/kg PFC). Animals were ventilated with oxygen for 4 h; the lungs were harvested for analysis of SOD distribution and oxidative injury. Cardiopulmonary indices remained stable and similar between groups. Qualitative assessment (QA) showed a more homogeneous lung SOD distribution in group II and a better histologic profile. QA of lung SOD distribution showed significant increase in SOD concentrations in group II (7.37 Ϯ 1.54 g/mg protein) compared with group I (1.65 Ϯ 0.23 g/mg protein). Oxidative injury as assessed by normalized protein carbonyl was 149.1 Ϯ 26.8% SEM in group II compared with 200.5 Ϯ 7.3% SEM in group I. Plasma SOD was significantly higher in group II. Administration of rhSOD with or without PFCs does not compromise cardiovascular function or impede lung recovery after ALI. PFCs enhance rhSOD delivery to the lungs by 400% while decreasing lung oxidative damage by 25% compared with rhSOD alone. These data suggest that PFCs optimize lung rhSOD delivery and might enhance the beneficial effects of rhSOD in preventing acute and chronic lung injury. (Pediatr Res 60: 65-70, 2006)

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Comparison of Ventilatory Support with Intratracheal Perfluorocarbon Administration and Conventional Mechanical Ventilation in Animals with Acute Respiratory Failure

Cited by 152 publications

References 25 publications

Partial liquid ventilation with small volumes of FC 3280 increases survival time in experimental ARDS

Partial liquid ventilation with small volumes of FC 3280 increases survival time in experimental ARDS

New strategies in mechanical ventilation for acute lung injury

Perfluorochemical Liquids Enhance Delivery of Superoxide Dismutase to the Lungs of Juvenile Rabbits

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