Hemodynamic effects of partial liquid ventilation with perfluorocarbon in acute lung injury

Abstract

Objective: To assess the effect of partial liquid ventilation with perfluorocarbons on hemodynamics and gas exchange in large pigs with induced acute lung injury (ALI). Design: Randomized, prospective, double-control, experimental study. Setting: Experimental intensive care unit of a university. Materials: Eighteen large pigs (50 _+ 5 kg body weight) with an average anterior posterior thoracic diameter of 24 cm and induced acute lung injury. Interventions: All animals were surfactant depleted by lung lavage to a PaO2 below 100 mmHg and randomized to receive either perflubron (n = 6) or saline (n = 6) in five intratracheal doses of 5 ml/kg at 20-rain intervals, or no instillation (n = 6). Measurements and results:In all animals heart rate, arterial pressures, pulmonary pressures, cardiac output and blood gases were recorded at 20-rain intervals. There was no deleterious effect on any hemodynamic parameter in the perflubron group, whereas systolic and mean pulmonary arterial pressure values showed a persistent decrease after the first 5 ml/kg of perflubron, from 48.7 _+ 14.1 to 40.8 _+ 11.7 mmHg and from 39.7 _+ 13.2 to 35.2 _+ 12.0 mmHg, respectively. Perflubron resulted in a significant (ANOVA P < 0.01), dose-dependent increase in PaO2 values from 86.3 _+ 22.4 to a maximum of 342.4 _+ 59.4 mmHg at a dose of 25 ml/kg; the other groups showed no significant increase in P.O2. Conclusions: Tracheal instillation of perflubron in induced ALI results in a dose-dependent increase in PaO2 and has no deleterious effect on hemodynamic parameters.

Combined Effect of Low-dose Nitric Oxide Gas Inhalation with Partial Liquid Ventilation on Hemodynamics, Pulmonary Function, and Gas Exchange in Acute Lung Injury of Newborn Piglets

“…The improvements in pulmonary mechanics might have further improved gas exchange during PLV in our study. Our results confirmed that there were no significant effects on systemic circulation by PLV, and these results were also compatible with previous studies (8,24). However, regarding pulmonary circulation, PLV decreased PAP significantly.…”

“…Because of its high density and low surface tension, perfluorocarbon recruits the atelectatic lung region. A number of animal studies reported an improvement in gas exchange with this technique (2)(3)(4)(5)(6)(7)(8)(9).…”

Dose Response to Aerosolized Perflubron in a Neonatal Swine Model of Lung Injury

“…However, a filling volume of 30 mL/kg of PFOB was shown to be more effective than 15 mL/kg in preterm lambs (31). After intratracheal administration of 5-25 mL/kg of liquid PFOB in 5-mL/kg doses, PaO 2 was significantly different from the control group only after administration of 15-25 mL/kg in adult pigs (32). In neonatal piglets, PLV with a filling volume of full residual capacity was more effective than a volume of half residual capacity in a bypass model (33).…”

Aerosolized Perfluorocarbon Suppresses Early Pulmonary Inflammatory Response in a Surfactant-Depleted Piglet Model

“…PLV is another approach to improve oxygenation, ventilation, lung mechanics, and histologic changes in critically impaired lungs (7)(8)(9)(10)(11)(12). PFCs are excellent solvents for carbon dioxide and oxygen and disperse easily because of their high spreading coefficient, recruiting collapsed alveoli.…”