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Morin C, Simard É, See W, Sage M, Imane R, Nadeau C, Samson N, Lavoie PM, Chabot B, Marouan S, Tremblay S, Praud JP, Micheau P, Fortin-Pellerin É. Total liquid ventilation in an ovine model of extreme prematurity: a randomized study. Pediatr Res 2024; 95:974-980. [PMID: 37833531 DOI: 10.1038/s41390-023-02841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/16/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND This study aimed at comparing cardiorespiratory stability during total liquid ventilation (TLV)-prior to lung aeration-with conventional mechanical ventilation (CMV) in extremely preterm lambs during the first 6 h of life. METHODS 23 lambs (11 females) were born by c-section at 118-120 days of gestational age (term = 147 days) to receive 6 h of TLV or CMV from birth. Lung samples were collected for RNA and histology analyses. RESULTS The lambs under TLV had higher and more stable arterial oxygen saturation (p = 0.001) and cerebral tissue oxygenation (p = 0.02) than the lambs in the CMV group in the first 10 min of transition to extrauterine life. Although histological assessment of the lungs was similar between the groups, a significant upregulation of IL-1a, IL-6 and IL-8 RNA in the lungs was observed after TLV. CONCLUSIONS Total liquid ventilation allowed for remarkably stable transition to extrauterine life in an extremely preterm lamb model. Refinement of our TLV prototype and ventilation algorithms is underway to address specific challenges in this population, such as minimizing tracheal deformation during the active expiration. IMPACT Total liquid ventilation allows for remarkably stable transition to extrauterine life in an extremely preterm lamb model. Total liquid ventilation is systematically achievable over the first 6 h of life in the extremely premature lamb model. This study provides additional incentive to pursue further investigation of total liquid ventilation as a transition tool for the most extreme preterm neonates.
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Affiliation(s)
- Christophe Morin
- Department of Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Émile Simard
- Department of Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Wendy See
- Department of Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Michaël Sage
- Department of Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Roqaya Imane
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | - Charlène Nadeau
- Department of Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nathalie Samson
- Department of Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Pascal M Lavoie
- Division of Neonatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Benoît Chabot
- Department of Microbiology and Infectiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Sofia Marouan
- Department of Pathology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Sophie Tremblay
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | - Jean-Paul Praud
- Department of Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Philippe Micheau
- Department of Mechanical Engineering, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Étienne Fortin-Pellerin
- Department of Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada.
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada.
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Sage M, See W, Nault S, Morin C, Michalski C, Chabot B, Marouan S, Lavoie PM, Micheau P, Praud JP, Fortin-Pellerin É. Effect of Low Versus High Tidal-Volume Total Liquid Ventilation on Pulmonary Inflammation. Front Physiol 2020; 11:603. [PMID: 32625110 PMCID: PMC7315809 DOI: 10.3389/fphys.2020.00603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/14/2020] [Indexed: 01/28/2023] Open
Abstract
Animal experiments suggest that total liquid ventilation (TLV) induces less ventilator-induced lung injury (VILI) than conventional mechanical gas ventilation. However, TLV parameters that optimally minimize VILI in newborns remain unknown. Our objective was to compare lung inflammation between low (L-VT) and high (H-VT) liquid tidal volume and evaluate impacts on the weaning process. Sixteen anesthetized and paralyzed newborn lambs were randomized in an L-VT group (initial tidal volume of 10 mL/kg at 10/min) and an H-VT group (initial tidal volume of 20 mL/kg at 5/min). Five unventilated newborn lambs served as controls. After 4 h of TLV in the supine position, the lambs were weaned in the prone position for another 4 h. The levels of respiratory support needed during the 4 h post-TLV were compared. The anterior and posterior lung regions were assessed by a histological score and real-time quantitative PCR for IL1B, IL6, and TNF plus 12 other exploratory VILI-associated genes. All but one lamb were successfully extubated within 2 h post-TLV (72 ± 26 min vs. 63 ± 25 min, p = 0.5) with similar FiO2 at 4 h post-TLV (27 ± 6% vs. 33 ± 7%, p = 0.3) between the L-VT and H-VT lambs. No significant differences were measured in histological inflammation scores between L-VT and H-VT lambs, although lambs in both groups exhibited slightly higher scores than the control lambs. The L-VT group displayed higher IL1B mRNA expression than the H-VT group in both anterior (2.8 ± 1.5-fold increase vs. 1.3 ± 0.4-fold increase, p = 0.02) and posterior lung regions (3.0 ± 1.0-fold change increase vs. 1.1 ± 0.3-fold increase, p = 0.002), respectively. No significant differences were found in IL6 and TNF expression levels. Gene expression changes overall indicated that L-VT was associated with a qualitatively distinct inflammatory gene expression profiles compared to H-VT, which may indicate different clinical effects. In light of these findings, further mechanistic studies are warranted. In conclusion, we found no advantage of lower tidal volume use, which was in fact associated with a slightly unfavorable pattern of inflammatory gene expression.
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Affiliation(s)
- Michaël Sage
- Department of Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Wendy See
- Department of Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Stéphanie Nault
- Department of Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Christophe Morin
- Department of Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Christina Michalski
- BC Children’s Hospital Research Institute, The University of British Columbia, Vancouver, BC, Canada
- Department of Experimental Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Benoit Chabot
- Department of Microbiology and Infectiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Sofia Marouan
- Department of Pathology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Pascal M. Lavoie
- BC Children’s Hospital Research Institute, The University of British Columbia, Vancouver, BC, Canada
- Department of Experimental Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
| | - Philippe Micheau
- Department of Mechanical Engineering, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Paul Praud
- Department of Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Étienne Fortin-Pellerin
- Department of Pharmacology-Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada
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Rambaud J, Lidouren F, Sage M, Kohlhauer M, Nadeau M, Fortin-Pellerin É, Micheau P, Zilberstein L, Mongardon N, Ricard JD, Terada M, Bruneval P, Berdeaux A, Ghaleh B, Walti H, Tissier R. Hypothermic total liquid ventilation after experimental aspiration-associated acute respiratory distress syndrome. Ann Intensive Care 2018; 8:57. [PMID: 29721820 PMCID: PMC5931951 DOI: 10.1186/s13613-018-0404-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 04/23/2018] [Indexed: 12/20/2022] Open
Abstract
Background Ultrafast cooling by total liquid ventilation (TLV) provides potent cardio- and neuroprotection after experimental cardiac arrest. However, this was evaluated in animals with no initial lung injury, whereas out-of-hospital cardiac arrest is frequently associated with early-onset pneumonia, which may lead to acute respiratory distress syndrome (ARDS). Here, our objective was to determine whether hypothermic TLV could be safe or even beneficial in an aspiration-associated ARDS animal model. Methods ARDS was induced in anesthetized rabbits through a two-hits model including the intra-tracheal administration of a pH = 1 solution mimicking gastric content and subsequent gaseous non-protective ventilation during 90 min (tidal volume [Vt] = 10 ml/kg with positive end-expiration pressure [PEEP] = 0 cmH2O). After this initial period, animals either received lung protective gas ventilation (LPV; Vt = 8 ml/kg and PEEP = 5 cmH2O) under normothermic conditions, or hypothermic TLV (TLV; Vt = 8 ml/kg and end-expiratory volume = 15 ml/kg). Both strategies were applied for 120 min with a continuous monitoring of respiratory and cardiovascular parameters. Animals were then euthanized for pulmonary histological analyses. Results Eight rabbits were included in each group. Before randomization, all animals elicited ARDS with arterial oxygen partial pressure over inhaled oxygen fraction ratios (PaO2/FiO2) below 100 mmHg, as well as decreased lung compliance. After randomization, body temperature rapidly decreased in TLV versus LPV group (32.6 ± 0.6 vs. 38.2 ± 0.4 °C after 15 min). Static lung compliance and gas exchanges were not significantly different in the TLV versus LPV group (PaO2/FiO2 = 62 ± 4 vs. 52 ± 8 mmHg at the end of the procedure, respectively). Mean arterial pressure and arterial bicarbonates levels were significantly higher in TLV versus LPV. Histological analysis also showed significantly lower inflammation in TLV versus LPV group (median histological score = 3 vs. 4.5/5, respectively; p = 0.03). Conclusion Hypothermic TLV can be safely induced in rabbits during aspiration-associated ARDS. It modified neither gas exchanges nor respiratory mechanics but reduced lung inflammation and hemodynamic failure in comparison with LPV. Since hypothermic TLV was previously shown to provide neuro- and cardio protective effects after cardiac arrest, these findings suggest a possible use of TLV in the settings of cardiac arrest-associated ARDS.
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Affiliation(s)
- Jérôme Rambaud
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France.,Paediatric and Neonatal Intensive Care Unit, Armand-Trousseau Hospital, UPMC, APHP, Paris, France
| | - Fanny Lidouren
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Michaël Sage
- Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Matthias Kohlhauer
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | | | | | | | - Luca Zilberstein
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Nicolas Mongardon
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France.,Service d'Anesthésie et des Réanimations Chirurgicales, DHU A-TVB, Hôpitaux Universitaires Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France
| | - Jean-Damien Ricard
- UMR 1137, Inserm, Université Paris Diderot, Hôpital Louis Mourier, Réanimation Médico-chirurgicale, APHP, Colombes, France
| | - Megumi Terada
- UMR 970, Inserm, Paris Cardiovascular Research Center, Hôpital Européen Georges Pompidou, Paris, France
| | - Patrick Bruneval
- UMR 970, Inserm, Paris Cardiovascular Research Center, Hôpital Européen Georges Pompidou, Paris, France
| | - Alain Berdeaux
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Bijan Ghaleh
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Hervé Walti
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France
| | - Renaud Tissier
- U955 - IMRB, Inserm, UPEC, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, 94700, Maisons-Alfort, France.
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Abstract
In this Editor's Review, articles published in 2017 are organized by category and summarized. We provide a brief reflection of the research and progress in artificial organs intended to advance and better human life while providing insight for continued application of these technologies and methods. Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level." Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. Peer-reviewed Special Issues this year included contributions from the 12th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion edited by Dr. Akif Undar, Artificial Oxygen Carriers edited by Drs. Akira Kawaguchi and Jan Simoni, the 24th Congress of the International Society for Mechanical Circulatory Support edited by Dr. Toru Masuzawa, Challenges in the Field of Biomedical Devices: A Multidisciplinary Perspective edited by Dr. Vincenzo Piemonte and colleagues and Functional Electrical Stimulation edited by Dr. Winfried Mayr and colleagues. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.
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Assessing the impacts of total liquid ventilation on left ventricular diastolic function in a model of neonatal respiratory distress syndrome. PLoS One 2018; 13:e0191885. [PMID: 29377922 PMCID: PMC5788374 DOI: 10.1371/journal.pone.0191885] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/12/2018] [Indexed: 11/20/2022] Open
Abstract
Background Filling the lung with dense liquid perfluorocarbons during total liquid ventilation (TLV) might compress the myocardium, a plausible explanation for the instability occasionally reported with this technique. Our objective is to assess the impacts of TLV on the cardiovascular system, particularly left ventricular diastolic function, in an ovine model of neonatal respiratory distress syndrome. Method Eight newborns lambs, 3.0 ± 0.4 days (3.2 ± 0.3kg) were used in this crossover experimental study. Animals were intubated, anesthetized and paralyzed. Catheters were inserted in the femoral and pulmonary arteries. A high-fidelity pressure catheter was inserted into the left ventricle. Surfactant deficiency was induced by repeated lung lavages with normal saline. TLV was then conducted for 2 hours using a liquid ventilator prototype. Thoracic echocardiography and cardiac output assessment by thermodilution were performed before and during TLV. Results Left ventricular end diastolic pressure (LVEDP) (9.3 ± 2.1 vs. 9.2 ± 2.4mmHg, p = 0.89) and dimension (1.90 ± 0.09 vs. 1.86 ± 0.12cm, p = 0.72), negative dP/dt (-2589 ± 691 vs. -3115 ± 866mmHg/s, p = 0.50) and cardiac output (436 ± 28 vs. 481 ± 59ml/kg/min, p = 0.26) were not affected by TLV initiation. Left ventricular relaxation time constant (tau) slightly increased from 21.5 ± 3.3 to 24.9 ± 3.7ms (p = 0.03). Mean arterial systemic (48 ± 6 vs. 53 ± 7mmHg, p = 0.38) and pulmonary pressures (31.3 ± 2.5 vs. 30.4 ± 2.3mmHg, p = 0.61) were stable. As expected, the inspiratory phase of liquid cycling exhibited a small but significant effect on most variables (i.e. central venous pressure +2.6 ± 0.5mmHg, p = 0.001; LVEDP +1.18 ± 0.12mmHg, p<0.001). Conclusions TLV was well tolerated in our neonatal lamb model of severe respiratory distress syndrome and had limited impact on left ventricle diastolic function when compared to conventional mechanical ventilation.
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