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

Abstract

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.

Effect of low???bias flow oscillation with partial liquid ventilation on fluoroscopic image analysis, gas exchange, and lung injury

“…Doctor et al (35) observed a significant reduction in atelectasis in a saline lavage-induced model of lung injury in swine treated with HFOV-PLV for 2 hrs after a 30-mL/kg dose of PFOB, in comparison with HFOV alone. The same investigators obtained similar findings in a subsequent study comparing two dosing strategies of HFOV-PLV (5 mL/kg in each the prone and supine position or 10 mL/kg in the supine position) and HFOV alone in a more severe, prolonged large animal model of injury (32). Smith et al (24) found that PLV with a conventional ventilator or PLV coupled with various high-frequency techniques (HFOV, jet, or flow interruption) resulted in attenuation of lung-injury scores in saline lavageinjured newborn piglets.…”

Persurf, a New Method to Improve Surfactant Delivery: A Study in Surfactant Depleted Rats

“…Thus, PFC associated recruitment of atelectatic alveoli [11], was also achieved in Persurf treated animals. In liquid ventilated animals atelectasis will re-appear after evaporation of PFC, since the underlying disturbances of pulmonary surfactant persist [41]. In contrast, the homogenous alveolar expansion should persist in Persurf treated animals after PFC evaporation since surfactant has been replaced.…”

Blunt bowel and mesenteric injuries in children: Do nonspecific computed tomography findings reliably identify these injuries?

“…By design, approximately half of the FRC in the HF-PLV1/2 group was liquid-filled at the start of treatment, and approximately 50% of that initial dose would still be present at 4 hrs, based on expected PFC evaporative loss under similar conditions (33,34). Two PFC dosing regimens were used to further evaluate the effect of PFC volume on outcome.…”