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Jeng MJ, Yang SS, Hwang B, Wolfson MR, Shaffer TH. Effects of perfluorochemical evaporative properties on oxygenation during partial liquid ventilation. Pediatr Int 2006; 48:608-15. [PMID: 17168983 DOI: 10.1111/j.1442-200x.2006.02287.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The physical-chemical properties of perfluorochemical (PFC) liquids have been shown to influence physiological and cellular responses during partial liquid ventilation (PLV). The aim of this study is to compare the relationship between patho-physiological endpoints and the physical properties of three PFC liquids used in treating acute lung injury. METHODS A total of 18 juvenile rabbits were randomized into conventional mechanical ventilation or PLV groups after lung saline lavages. Three PFC liquids, including Flutec perfluoro-1,3,5-trimethylcyclohexane (PP4; vapor pressure, 28.8 mmHg at 37 degrees C), Perfluorodecalin (PFD; vapor pressure, 13.6 mmHg at 37 degrees C), and Perflubron (PFB; vapor pressure, 10.4 mmHg at 37 degrees C) were used for PLV with no replacement for 4 h. A thermal detector was used to measure PFC loss rate. Physiological measurements and evaporative loss rate of PFC were done every 30 min, and lung histology was examined. RESULTS The mean evaporative loss rate was significantly higher in the PP4 group (4.75 +/- 0.24 mL/kg per h) than in either the PFD (1.43 +/- 0.11 mL/kg per h) or the PFB (1.18 +/- 0.05 mL/kg per h) group (P < 0.05). The oxygenation of PFD and PFB was maintained good for 4 h, however, the PP4 group showed a fast deterioration since 2 h post-treatment due to fast dropping of the residual PP4 amount in lungs. Histology showed good alveolar integrity in the PFD and PFB groups. CONCLUSIONS The effects of PLV are directly influenced by the evaporative property of the PFC liquid. With no replacement over 4 h, PLV effects could be maintained with utilizing a PFC liquid with low, rather than high, vapor pressure. PFC with high vapor pressure has a high loss rate and low residual volume that causes poor maintenance on oxygenation during PLV. Therefore, measuring PFC loss rate is important in future studies and clinical application of PLV.
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Affiliation(s)
- Mei-Jy Jeng
- Department of Pediatrics, Taipei Veterans General Hospital, Taichung, Taiwan.
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Wilms CT, Schober P, Kalb R, Loer SA. Partial liquid ventilation: effects of closed breathing systems, heat-and-moisture-exchangers and sodalime absorbers on perfluorocarbon evaporation. Eur J Anaesthesiol 2006; 23:31-5. [PMID: 16390562 DOI: 10.1017/s0265021505001729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2005] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES During partial liquid ventilation perfluorocarbons are instilled into the airways from where they subsequently evaporate via the bronchial system. This process is influenced by multiple factors, such as the vapour pressure of the perfluorocarbons, the instilled volume, intrapulmonary perfluorocarbon distribution, postural positioning and ventilatory settings. In our study we compared the effects of open and closed breathing systems, a heat-and-moisture-exchanger and a sodalime absorber on perfluorocarbon evaporation during partial liquid ventilation. METHODS Isolated rat lungs were suspended from a force transducer. After intratracheal perfluorocarbon instillation (10 mL kg(-1)) the lungs were either ventilated with an open breathing system (n = 6), a closed breathing system (n = 6), an open breathing system with an integrated heat-and-moisture-exchanger (n = 6), an open breathing system with an integrated sodalime absorber (n = 6), or a closed breathing system with an integrated heat-and-moisture-exchanger and a sodalime absorber (n = 6). Evaporative perfluorocarbon elimination was determined gravimetrically. RESULTS When compared to the elimination half-life in an open breathing system (1.2 +/- 0.07 h), elimination half-life was longer with a closed system (6.4 +/- 0.9 h, P 0.05) when compared to a closed system. CONCLUSIONS Evaporative perfluorocarbon loss can be reduced effectively with closed breathing systems, followed by the use of sodalime absorbers and heat-and-moisture-exchangers.
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Affiliation(s)
- C T Wilms
- Heinrich-Heine-University Düsseldorf, Department of Anaesthesiology, Germany
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Wiryawan B, Dowhy MS, Fuhrman BP, Rotta AT. Effect of low-bias flow oscillation with partial liquid ventilation on fluoroscopic image analysis, gas exchange, and lung injury. Pediatr Crit Care Med 2005; 6:690-7. [PMID: 16276337 DOI: 10.1097/01.pcc.0000171156.17113.2d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effect of low-bias flow oscillation (LBFO) with partial liquid ventilation (PLV) on perfluorochemical evaporation, histopathology, and oxidative tissue damage in an animal model of acute lung injury. DESIGN Prospective, randomized animal study. SETTING Research laboratory of a health sciences university. SUBJECTS Twelve New Zealand White rabbits. INTERVENTIONS Juvenile rabbits were anesthetized, paralyzed, and ventilated through a tracheostomy with either high-frequency oscillatory ventilation or LBFO. Lung injury was induced by repeated saline lavage, after which perflubron was instilled through a side port of the endotracheal tube. Lateral fluoroscopic images were performed at baseline and at various postfill intervals of animals in the high-frequency oscillatory ventilation-PLV and LBFO-PLV groups. The images were digitalized for computer analysis of the Lung Lucency Index, a surrogate marker of perflubron evaporation. Histopathologic evaluation was performed using a lung-injury scoring system. Malondialdehyde was measured in lung homogenates to assess oxidative damage. MEASUREMENTS AND MAIN RESULTS There were no significant differences in gas exchange and ventilator settings between groups throughout the experiment. At 300 mins, the high-frequency oscillatory ventilation-PLV group had a significantly higher Lung Lucency Index compared with the LBFO-PLV group in both dependent and nondependent lung regions (a high Lung Lucency Index correlates with increased perflubron loss). Malondialdehyde measurements were not different between groups. Animals treated with LBFO-PLV had a lower histopathologic lung-injury score compared with high-frequency oscillatory ventilation-PLV. CONCLUSION LBFO-PLV is a viable mode of ventilation in a model of acute lung injury and is associated with significant preservation of perflubron in comparison with high-frequency oscillatory ventilation-PLV. The lower evaporative losses during LBFO-PLV were associated with improved histology scores.
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Affiliation(s)
- Budi Wiryawan
- Division of Pediatric Critical Care, The Women and Children's Hospital of Buffalo, State University of New York at Buffalo, NY, USA
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Kandler MA, von der Hardt K, Gericke N, Chada M, Dötsch J, Rascher W. Dose response to aerosolized perflubron in a neonatal swine model of lung injury. Pediatr Res 2004; 56:191-7. [PMID: 15181181 DOI: 10.1203/01.pdr.0000132667.47744.f4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aerosolized perfluorocarbon (PFC) improves gas exchange, lung mechanics, and pulmonary artery pressure. The objective of this intervention was to study the dose-response effect to aerosolized perfluorooctylbromide (PFOB; perflubron, LiquiVent, Alliance Pharmaceutical Corp.) in surfactant-depleted piglets. After induction of lung injury by saline lavage, 25 newborn piglets were randomly assigned to receive 0, 1.25, 2.5, 5.0, or 7.5 mL/kg aerosolized PFOB per hour. A 2-h therapy period was followed by a 3-h observation period. In all animals, respiratory support was performed with intermittent mandatory ventilation. After aerosol treatment and 3 h of observation, arterial oxygen pressure was similarly improved in the 2.5-, 5.0-, and 7.5-mL. kg(-1). h(-1) aerosol-PFOB groups and higher compared with the 1.25-mL. kg(-1). h(-1) aerosol-PFOB (P < 0.01) and the control groups (P < 0.001). Compared with the control group, arterial carbon dioxide pressure was significantly reduced with 2.5-, 5.0-, and 7.5-mL. kg(-1). h(-1) aerosol-PFOB (P < 0.001). Treatment with 1.25 mL. kg(-1). h(-1) aerosol-PFOB did not significantly affect arterial carbon dioxide pressure. The 20% terminal dynamic compliance/dynamic compliance was significantly improved in the groups that received 2.5, 5.0, and 7.5 mL. kg(-1). h(-1) aerosol-PFOB compared with control animals. Mean pulmonary artery pressure was lower after therapy with 5.0 and 7.5 mL. kg(-1). h(-1) aerosol-PFOB (P < 0.01) than in the control group. IL-1beta gene expression in lung tissue was significantly reduced with PFOB 1.25 mL. kg(-1). h(-1). In summary, aerosolized PFOB improved terminal dynamic compliance, pulmonary gas exchange, and pulmonary artery pressure in a dose-dependent manner. In terms of oxygenation and lung mechanics, the optimum dose was between 2.5 and 5 mL. kg(-1). h(-1).
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Trevisanuto D, Jeng MJ, Weis CM, Fox WW, Wolfson MR, Shaffer TH. Positive end-expiratory pressure modulates perfluorochemical evaporation from the lungs. Neonatology 2004; 84:53-8. [PMID: 12890937 DOI: 10.1159/000071444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
To study the effects of positive end-expiratory pressure (PEEP) level on perfluorochemical (PFC) elimination profiles (E(L)), 6 ml/kg of perflubron were instilled into healthy anesthetized rabbits. The ventilation strategy was to maintain constant minute ventilation (300 ml/kg/min) and mean airway pressure (7-8 cm H(2)O) while randomly changing the PEEP levels from 5 to 0, 1, 3, and 10 cm H(2)O, each for a period of 15 min. The PFC content in the expired gas was measured and the E(L) was calculated. There was a significant reduction in the E(L) when decreasing the PEEP levels from 5 to 0 cm H(2)O, but no differences were seen when the PEEP was increased from 5 to 10 cm H(2)O. The results indicate that PEEP levels influence PFC elimination profiles; therefore, the measurement of the E(L) and PEEP levels should be considered when optimizing supplemental PFCs during partial liquid ventilation.
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Affiliation(s)
- D Trevisanuto
- Department of Pediatrics, Padua University, Padua, Italy.
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Loer SA, Schwarte LA, Pakulla MA, Picker O, Scheeren TWL. Partial liquid ventilation: effects of positive end-expiratory pressure on perfluorocarbon evaporation from the lungs of anesthetized dogs. Intensive Care Med 2003; 29:467-70. [PMID: 12577153 DOI: 10.1007/s00134-003-1642-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2002] [Accepted: 12/10/2002] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Perfluorocarbons are eliminated during partial liquid ventilation mainly by evaporation via the airways. We examined whether this is affected by the level of end-expiratory airway pressure. DESIGN AND SETTING Observational cohort animal study in the animal laboratory of a university hospital. SUBJECTS Five foxhound dogs. INTERVENTIONS The anesthetized dogs underwent partial liquid ventilation (5 ml/kg perfluorocarbon) at constant respiratory rate (17+/-1 breaths/min) and tidal volume (10 ml/kg). The level of end-expiratory airway pressure was varied repeatedly between 0, 5, and 10 cmH(2)O every 25 min. MEASUREMENTS AND RESULTS Expired gas was collected in reservoirs to determine evaporative perfluorocarbon loss gravimetrically. Any increase in end-expiratory airway pressure increased while any decrease in end-expiratory airway pressure reduced evaporative perfluorocarbon loss. Mean initial elimination at an end-expiratory airway pressure of 5 cmH(2)O was 19.6+/-3.8 microl/kg per minute; this decreased by 28% at an end-expiratory airway pressure of 0 cmH(2)O and increased by 46% at an end-expiratory airway pressure of 10 cmH(2)O. At equal levels of end-expiratory airway pressure evaporation decreased linearly over time. CONCLUSIONS Our results suggest that the level of end-expiratory airway pressure is a determinant of evaporative perfluorocarbon loss and may have relevance for maintenance dosing and instillation intervals during partial liquid ventilation.
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Affiliation(s)
- Stephan A Loer
- Department of Anaesthesiology, University Hospital Düsseldorf, Heinrich Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany.
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Jeng MJ, Yang SS, Wolfson MR, Shaffer TH. Perfluorochemical (PFC) combinations for acute lung injury: an in vitro and in vivo study in juvenile rabbits. Pediatr Res 2003; 53:81-8. [PMID: 12508085 DOI: 10.1203/00006450-200301000-00015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Perfluorochemical (PFC) fluids of different physical properties were titrated and tested in vitro for physical properties that are appropriate for respiratory application. Two PFC liquids were studied: perfluoromethylcyclohexane (PP2), a liquid with high vapor pressure and low viscosity, and perfluoromethyldecalin (PP9), a fluid with low vapor pressure and high viscosity. Eighteen rabbits (2.05 +/- 0.07 kg; mean +/- SEM) were lung-lavaged and randomized: group I, control group; group II, partial liquid ventilation with 75% PP2 and 25% PP9; group III, partial liquid ventilation with 50% PP2 and 50% PP9; and group IV, partial liquid ventilation with 25% PP2 and 75% PP9. Ventilator volumes were kept constant during the 4-h experiment. Cardiopulmonary measurements were performed every 30 min. The lung histology was examined. The in vitro study showed PFC [viscosity/vapor pressure (in cS and mm Hg, respectively)] as follows: 100% PP2 (0.88/141); 100% PP9 (3.32/2.9); 75% PP2 and 25% PP9 (1.26/107); 50% PP2 and 50% PP9 (1.63/13.7); and 25% PP2 and 75% PP9 (2.21/4.4). The in vivo experiments found that combinations of moderate vapor pressure (groups 3 and 4) demonstrated good gas exchange, compliance, and histologic findings. Thus, combinations of PFC liquids can be formulated to modulate the physiologic outcome in acutely injured lungs, and may prove useful for alternative PFC liquid applications.
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Affiliation(s)
- Mei-Jy Jeng
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, and Department of Pediatrics, Children's Medical Center, Veterans General Hospital-Taipei, Taipei 112, Taiwan.
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Jeng MJ, Oliver R, Wolfson MR, Shaffer TH. Partial liquid ventilation: Effect of initial dose and redosing strategy in acute lung injury. Pediatr Crit Care Med 2002; 3:163-170. [PMID: 12780988 DOI: 10.1097/00130478-200204000-00014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE: Partial liquid ventilation (PLV) with perfluorochemicals has been shown to be effective in treating acute respiratory failure in animal studies and human trials. To determine the influences of perfluorochemicals on initial dose and redosing strategy, we studied their effects on gas exchange, pulmonary mechanics, and lung architecture. DESIGN: After lung injury was induced by repeated warm saline lavages, the animals were instilled endotracheally with different doses of perflubron during 5-10 mins in PLV-treated groups. The animals were randomized to five groups: PLV-12S (12 mL/kg perflubron, single dose), PLV-12M (12 mL/kg perflubron, multiple replacement doses), PLV-18S (18 mL/kg perflubron, single dose), PLV-18M (18 mL/kg perflubron, multiple replacement doses), and the control group (conventional mechanical ventilation only). Ventilator settings were kept constant during the 4-hr experiment. SETTING: An animal laboratory affiliated with Temple University School of Medicine. SUBJECTS: Twenty-eight New Zealand White juvenile rabbits (weight, 1.96 +/- 0.03 kg). INTERVENTIONS: Physiologic data were recorded every 30 mins. A constant volume (1.3 mL/kg/hr) of perflubron was replaced hourly in the PLV-12M and PLV-18M groups. The perflubron in the expired gas was measured with a thermal detector device. The hourly evaporative loss rate and the estimated residual perfluorochemical amount were calculated and analyzed. Histologic examinations of the lungs were performed. MEASUREMENTS AND MAIN RESULTS: All animals in the PLV-treated groups (PLV-12S, n = 4; PLV-12M, n = 5, PLV-18S, n = 5; PLV-18M, n = 4) demonstrated improvements in gas exchange and respiratory compliance that were significantly (p <.05) better than the control group (n = 8). However, the PLV-12S group demonstrated progressive deterioration after the initial improvement. The loss rate of perflubron did not differ among the PLV-treated groups (1.17 +/- 0.03 mL/kg/hr), but the residual perfluorochemical volume in the lungs decreased progressively and significantly in the PLV-12S and PLV-18S groups as a function of time (p <.05). Histologic examination showed good alveolar protection in the PLV-12M, PLV-18S, and PLV-18M groups. CONCLUSIONS: We conclude that the low initial dose (12 mL/kg, about two thirds the functional residual capacity volume of rabbits) of perflubron required hourly replacement to maintain the effects of PLV. With a high initial dose of 18 mL/kg perflubron (equal to a full functional residual capacity volume in rabbits), the responses are potentiated in both single and multiple dosing groups up to 4 hrs.
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Affiliation(s)
- Mei-Jy Jeng
- Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China; and the Department of Pediatrics, Children's Medical Center, Veterans General Hospital-Taipei, Taipei, Taiwan, Republic of China; the Division of Neonatology, Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA; the Departments of Physiology and Pediatrics, Temple University School of Medicine, Philadelphia, PA (MRW, THS); and the Nemours Lung Center, Alfred I. duPont Hospital for Children, Wilmington, DE. E-mail:
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Jeng MJ, Kou YR, Sheu CC, Hwang B. Effects of partial liquid ventilation with FC-77 on acute lung injury in newborn piglets. Pediatr Pulmonol 2002; 33:12-21. [PMID: 11747255 DOI: 10.1002/ppul.10021] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Partial liquid ventilation (PLV) with various types of perfluorochemicals (PFC) has been shown to be beneficial in treating acute lung injury. FC-77 is a type of PFC with relatively high vapor pressure and evaporative losses during PLV. This study tested the hypothesis that using FC-77 for PLV with hourly replacement is effective in treating acute lung injury. Fifteen neonatal piglets were randomly and evenly divided into 3 study groups: 1) lavage-induced lung injury followed by conventional mechanical ventilation (Lavage-CMV); 2) lavage-induced lung injury followed by PLV using FC-77 with hourly replacement (11.2 +/- 1.5 mL/kg/hr) (Lavage-PLV); and 3) sham lavage injury followed by conventional mechanical ventilation (Control). Immediately after induction, repeated saline lavages induced acute lung injury characterized by decreases in dynamic lung compliance, arterial oxygen tension, and arterial pH, and increases in arterial CO(2) tension and oxygenation index, whereas the sham lavage procedure failed to do so. During the 3-hr period of CMV, these pulmonary and cardiovascular parameters remained stable in the Control group, but deteriorated in the Lavage-CMV group. In contrast, after acute lung injury, low lung compliance, abnormal gas exchange, acidosis, and inadequate oxygenation significantly improved in the Lavage-PLV group. Histological analysis of these 3 study groups revealed that the Lavage-CMV group had the highest lung injury score and the Control group had the lowest. These results suggest that, in comparison to CMV, PLV with FC-77 and hourly replacement of FC-77 promotes more favorable pulmonary mechanics, gas exchange, oxygenation, and lung histology in a piglet model of acute lung injury.
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Affiliation(s)
- Mei-Jy Jeng
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
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