Low-dose perfluorocarbon: a revival for partial liquid ventilation?

Tracheal gas insufflation with partial liquid ventilation to treat LPS-induced acute lung injury in juvenile piglets

OBJECTIVES

Partial liquid ventilation (PLV) with perfluorocarbons (PFC) seems not superior to conventional ventilation clinically. We hypothesized that a combination of continuous tracheal gas insufflation (TGI) with protective strategy of PLV (low dose of PFC, low inflation pressure, moderate inhalation of oxygen and moderate anesthesia) would improve cardiopulmonary function in acute lung injury.

METHODS

Twenty-four healthy juvenile piglets were anesthetized and mechanically ventilated at PEEP of 2 cmH(2)O with a peak inspiratory pressure of 10 cmH(2)O and FIO(2) of 0.4. The piglets were challenged with lipopolysaccharide and randomly assigned to four groups (n = 6 each): (1) mechanical ventilation alone (MV); (2) PLV with perfluorodecalin (10 ml/kg); (3) TGI with continuous airway flow 2 L/min; and (4) combination of PLV and TGI. The outcome was assessed functionally and histologically.

RESULTS

All treatments except MV improved pH, PaO(2)/FIO(2), PaCO(2), ventilation efficacy index (VEI) and tidal volume. Both PLV-associated treatments also improved heart rate, respiratory rate, pulse contour cardiac output, systemic vascular resistance, dynamic lung compliance, mean airway resistance and mean airway pressure. The combination group resulted in higher PaO(2)/FIO(2), VEI and a better lung histology score than any other treatments.

CONCLUSIONS

The new protective strategy may provide a better treatment for sepsis-induced acute lung injury.

Partial liquid ventilation confers protection against acute lung injury induced by endotoxin in juvenile piglets

To investigate the effect of partial liquid ventilation (PLV) at low inflation pressures on acute lung injury (ALI), endotoxin was administered to healthy anesthetized juvenile piglets. The animals were randomly assigned to two groups, n=6 each: (1) conventional mechanical ventilation (MV) and (2) PLV with perfluorodecalin (10 mL kg(-1)). Compared with MV, PLV improved each cardiopulmonary variable measured. These variables included pulse contour cardiac output, heart rate, blood pH, breathing rate, both partial pressure of arterial oxygen (PaO2) and PaO2/FIO2 (fraction of inspired oxygen), partial pressure of arterial carbon dioxide (PaCO2), dynamic lung compliance, tidal volume, and ventilation efficacy index. Lung morphology also showed less damage in the PLV group, even in non-dependent regions (P<0.05). Our data support the hypothesis that PLV can decrease pulmonary damage, improve gas exchange and cardiac output, and may lead to a better prognosis in endotoxin-induced ALI.