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Voelker MT, Laudi S, Henkelmann J, Bercker S. ECMO and perfluorocarbon in a therapy refractory case of Acute Respiratory Distress Syndrome. Ann Thorac Surg 2021; 113:e355-e358. [PMID: 34418344 PMCID: PMC8372475 DOI: 10.1016/j.athoracsur.2021.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/24/2021] [Accepted: 07/29/2021] [Indexed: 11/01/2022]
Abstract
Perfluorocarbons are oxygen-carrying, dense liquids initially intended for the use in partial or total liquid ventilation in patients with severe acute respiratory distress syndrome (ARDS), but did not show beneficial effects in clinical studies. However, perfluorocarbons may be used for lung lavage in severe alveolar proteinosis. In ARDS, oxygenation may be so severely compromised that the use of non-oxygenated perfluorocarbons may not be possible. We report of a case of severe non-resolving ARDS treated with extracorporeal membrane oxygenation (ECMO) to secure oxygenation, using perfluorocarbon in a single instillation to aid the clearance of debris and proteinacous edema.
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Affiliation(s)
- Maria T Voelker
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Germany.
| | - Sven Laudi
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Germany
| | - Jeanette Henkelmann
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Germany
| | - Sven Bercker
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Germany
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2
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Eichenwald C, Dysart K, Zhang H, Fox W. Neonatal Partial Liquid Ventilation for the Treatment and Prevention of Bronchopulmonary Dysplasia. Neoreviews 2020; 21:e238-e248. [PMID: 32238486 DOI: 10.1542/neo.21-4-e238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Connor Eichenwald
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kevin Dysart
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Huayan Zhang
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - William Fox
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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3
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Rohlffs F, Trepte C, Ivancev K, Tsilimparis N, Makaloski V, Debus ES, Kölbel T. Air Embolism During TEVAR: Liquid Perfluorocarbon Absorbs Carbon Dioxide in a Combined Flushing Technique and Decreases the Amount of Gas Released From Thoracic Stent-Grafts During Deployment in an Experimental Setting. J Endovasc Ther 2018; 26:76-80. [DOI: 10.1177/1526602818819501] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Purpose:To investigate the influence of flushing thoracic stent-grafts with carbon dioxide and perfluorocarbon on the amount of gas released during stent-graft deployment in thoracic endovascular aortic repair (TEVAR). Materials and Methods: Ten TX2 ProForm thoracic stent-grafts were deployed into a water-filled container with a curved plastic pipe and flushed sequentially with carbon dioxide, 20 mL of liquid perfluorocarbon (PFC), and 60 mL of saline. Released gas was measured using a calibrated setup. The volume of released gas was compared with the results of an earlier published reference group, in which identical stent-grafts were flushed with 60 mL saline alone as recommended in the instructions for use. Results: The average amount of gas released in the test group was 0.076 mL, significantly lower (p<0.001) than the mean 0.79 mL of gas released in the reference group. Big bubbles appearing at the tip of the sheath when deployment was started were seen in all grafts of the reference group but in only 2 of the test group stent-grafts. Small bubbles were less frequent in the test group. Conclusion: The amount of gas released from thoracic stent-grafts during deployment can be influenced by different flushing techniques. The use of PFC in addition to the carbon dioxide flushing technique reduces the volume of gas released during deployment of tubular thoracic stent-grafts to a few microliters. This significant effect is presumably based on the high solubility of carbon dioxide in perfluorocarbon and could be a potential future approach to lower the risk of cerebral injury and stroke from air embolism during TEVAR.
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Affiliation(s)
- Fiona Rohlffs
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Constantin Trepte
- Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Krassi Ivancev
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Vladimir Makaloski
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - E. Sebastian Debus
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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4
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Nelson DL, Zhao Y, Fabiilli ML, Cook KE. In vitro evaluation of lysophosphatidic acid delivery via reverse perfluorocarbon emulsions to enhance alveolar epithelial repair. Colloids Surf B Biointerfaces 2018; 169:411-417. [PMID: 29807339 DOI: 10.1016/j.colsurfb.2018.05.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Alveolar drug delivery is needed to enhance alveolar repair during acute respiratory distress syndrome. However, delivery of inhaled drugs is poor in this setting. Drug delivery via liquid perfluorocarbon emulsions could address this problem through better alveolar penetration and improved spatial distribution. Therefore, this study investigated the efficacy of the delivery of lysophosphatidic acid (LPA) growth factor to cultured alveolar epithelial cells via a perfluorocarbon emulsion. METHODS Murine alveolar epithelial cells were treated for 2 h with varying concentrations (0-10 μM) of LPA delivered via aqueous solution or PFC emulsion. Cell migration was evaluated 18 h post-treatment using a scratch assay. Barrier function was evaluated 1 h post-treatment using a permeability assay. Proliferation was evaluated 72 h post-treatment using a viability assay. RESULTS Partially due to emulsion creaming and stability, the effects of LPA were either diminished or completely hindered when delivered via emulsion versus aqueous. Migration increased significantly following treatment with the 10 μM emulsion (p < 10-3), but required twice the concentration to achieve an increase similar to aqueous LPA. Both barrier function and proliferation increased following aqueous treatment, but neither were significantly affected by the emulsion. CONCLUSIONS The availability and thus the biological effect of LPA is significantly blunted during emulsified delivery in vitro, and this attenuation depends on the specific cellular function examined. Thus, the cellular level effects of drug delivery to the lungs via PFC emulsion are likely to vary based on the drug and the effect it is intended to create.
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Affiliation(s)
- Diane L Nelson
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Scott Hall 4th Floor, Pittsburgh, PA, 15213, USA.
| | - Yutong Zhao
- Department of Medicine, University of Pittsburgh, Division of Pulmonary, Allergy and Critical Care Medicine, East 1200A Biomedical Science Tower, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| | - Mario L Fabiilli
- Department of Radiology, University of Michigan, 3226A Medical Sciences Building I, 1301 Catherine Street, Ann Arbor, MI, 48109, USA.
| | - Keith E Cook
- Department of Biomedical Engineering, Carnegie Mellon University, 5000 Forbes Avenue, Scott Hall 4th Floor, Pittsburgh, PA, 15213, USA.
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5
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Caridi-Scheible ME, Blum JM. Use of Perfluorodecalin for Bronchoalveolar Lavage in Case of Severe Pulmonary Hemorrhage and Extracorporeal Membrane Oxygenation. ACTA ACUST UNITED AC 2016; 7:215-218. [DOI: 10.1213/xaa.0000000000000389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Green FHY, Leigh R, Fadayomi M, Lalli G, Chiu A, Shrestha G, ElShahat SG, Nelson DE, El Mays TY, Pieron CA, Dennis JH. A phase I, placebo-controlled, randomized, double-blind, single ascending dose-ranging study to evaluate the safety and tolerability of a novel biophysical bronchodilator (S-1226) administered by nebulization in healthy volunteers. Trials 2016; 17:361. [PMID: 27464582 PMCID: PMC4964056 DOI: 10.1186/s13063-016-1489-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 06/21/2016] [Indexed: 11/13/2022] Open
Abstract
Background A major challenge in treating acute asthma exacerbations is the need to open constricted airways rapidly enough to reestablish ventilation and allow delivery of conventional medication to diseased airways. The solution requires a new approach that considers both biophysical and pharmacological aspects of treatments used in acute asthma. The result of testing several formulations was S-1226: carbon dioxide-enriched air delivered in nebulized perflubron, a synthetic surfactant. These agents act synergistically to rapidly reopen closed airways within seconds. The bronchodilator effect is independent of β-adrenergic and cholinergic mediated-signaling pathways, offering a unique mechanism of action. S-1226 has a low toxicity profile and was effective in treating bronchoconstriction in animal models of asthma. The goal of the present study was to evaluate the safety and tolerability of S-1226 in healthy human subjects. Methods The phase I study was a single-center, randomized, double-blind, placebo-controlled, sequential, single-ascending-dose study conducted in Canada. Thirty-six subjects were distributed into three cohorts. Within each cohort, subjects were randomized to receive a single dose of S-1226 or a matching placebo administered over a 2-minute nebulization period. S-1226 was formulated with perflubron and 4 %, 8 %, or 12 % CO2. The dose of CO2 was sequentially escalated by cohort. The safety and tolerability of S-1226 were evaluated through assessment of adverse events, vital signs, 12-lead electrocardiograms, clinical laboratory parameters, and physical examinations. Results S-1226 was safe and well tolerated at all three CO2 levels (4 %, 8 %, and 12 %). A total of 28 adverse events were reported, and all were judged mild in severity. Twenty-four adverse events occurred in the S-1226 cohort, of which five were considered remotely related and six possibly related to S-1226. Conclusions S-1226 is a novel drug being developed for the treatment of acute asthma exacerbations. It consists of CO2-enriched air and perflubron and has potential to offer rapid and potent bronchodilation. The results of the study indicate that S-1226 is safe and well tolerated. All adverse events were mild, reversible, and likely due to known side effects of CO2 inhalation. Trial registration ClinicalTrials.gov NCT02616770. Registered on 25 November 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1489-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francis H Y Green
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada.
| | - Richard Leigh
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Morenike Fadayomi
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Andrea Chiu
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada.,SolAeroMed Inc., Calgary, AB, Canada
| | - Grishma Shrestha
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | | | - David Evan Nelson
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Tamer Y El Mays
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada
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7
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Horvat CM, Carcillo JA, Dezfulian C. Liquid fluorocarbon lavage to clear thrombus from the distal airways after severe pulmonary hemorrhage requiring extracorporeal life support (ECLS). Respir Med Case Rep 2015; 15:7-8. [PMID: 26236589 PMCID: PMC4501460 DOI: 10.1016/j.rmcr.2015.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Massive pulmonary hemorrhage can pose a significant therapeutic challenge. Traditional methods of airway clearance using saline lavage and direct thrombus removal via bronchoscopy have limited ability to retrieve thrombi from deep airways. We report a patient on extracorporeal life support with massive pulmonary hemorrhage resulting in extensive alveolar and airway thrombus extending well beyond the proximal airways and the novel use of perfluorodecalin lavage to facilitate airway clearance and lung recruitment. Clinical trial registration None.
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Affiliation(s)
- Christopher M Horvat
- Department of Critical Care, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joseph A Carcillo
- Department of Critical Care, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Cameron Dezfulian
- Department of Critical Care, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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8
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Chenoune M, De Rochefort L, Bruneval P, Lidouren F, Kohlhauer M, Seemann A, Ghaleh B, Korn M, Dubuisson RM, Ben Yahmed A, Maître X, Isabey D, Ricard JD, Kerber RE, Darrasse L, Berdeaux A, Tissier R. Evaluation of lung recovery after static administration of three different perfluorocarbons in pigs. BMC Pharmacol Toxicol 2014; 15:53. [PMID: 25253660 PMCID: PMC4177717 DOI: 10.1186/2050-6511-15-53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 09/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The respiratory properties of perfluorocarbons (PFC) have been widely studied for liquid ventilation in humans and animals. Several PFC were tested but their tolerance may depend on the species. Here, the effects of a single administration of liquid PFC into pig lungs were assessed and compared. Three different PFC having distinct evaporative and spreading coefficient properties were evaluated (Perfluorooctyl bromide [PFOB], perfluorodecalin [PFD] and perfluoro-N-octane [PFOC]). METHODS Pigs were anesthetized and submitted to mechanical ventilation. They randomly received an intra-tracheal administration of 15 ml/kg of either PFOB, PFD or PFOC with 12 h of mechanical ventilation before awakening and weaning from ventilation. A Control group was submitted to mechanical ventilation with no PFC administration. All animals were followed during 4 days after the initial PFC administration to investigate gas exchanges and clinical recovery. They were ultimately euthanized for histological analyses and assessment of PFC residual concentrations within the lungs using dual nuclei fluorine and hydrogen Magnetic Resonance Imaging (MRI). Sixteen animals were included (4/group). RESULTS In the PFD group, animals tended to be hypoxemic after awakening. In PFOB and PFOC groups, blood gases were not significantly different from the Control group after awakening. The poor tolerance of PFD was likely related to a large amount of residual PFC, as observed using MRI in all lung samples (≈10% of lung volume). This percentage was lower in the PFOB group (≈1%) but remained significantly greater than in the Control group. In the PFOC group, the percentage of residual PFC was not significantly different from that of the Control group (≈0.1%). Histologically, the most striking feature was an alveolar infiltration with foam macrophages, especially in the groups treated by PFD or PFOB. CONCLUSIONS Of the three tested perfluorocarbons, PFOC offered the best tolerance in terms of lung function, gas exchanges and residuum in the lung. PFOC was rapidly cleared from the lungs and virtually disappeared after 4 days whereas PFOB persisted at significant levels and led to foam macrophage infiltration. PFOC could be relevant for short term total liquid ventilation with a rapid weaning.
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9
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Galvin IM, Steel A, Pinto R, Ferguson ND, Davies MW. Partial liquid ventilation for preventing death and morbidity in adults with acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev 2013; 2013:CD003707. [PMID: 23881653 PMCID: PMC6516802 DOI: 10.1002/14651858.cd003707.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are syndromes of severe respiratory failure that are associated with substantial mortality and morbidity. Artifical ventilatory support is commonly required and may exacerbate lung injury. Partial liquid ventilation (PLV) has been proposed as a less injurious form of ventilatory support for these patients. Although PLV has been shown to improve gas exchange and to reduce inflammation in experimental models of ALI, a previous systematic review did not find any evidence to support or refute its use in humans with ALI and ARDS. OBJECTIVES The primary objective of this review was to assess whether PLV reduced mortality (at 28 d, at discharge from the intensive care unit (ICU), at discharge from hospital and at one, two and five years) in adults with ALI or ARDS when compared with conventional ventilatory support.Secondary objectives were to determine how PLV compared with conventional ventilation with regard to duration of invasive mechanical ventilation, duration of respiratory support, duration of oxygen therapy, length of ICU stay, length of hospital stay, incidence of infection, long-term cognitive impairment, long-term health related quality of life, long- term lung function, long-term morbidity costs and adverse events. The following adverse events were considered: hypoxia (arterial PO2 <80 mm Hg), pneumothorax (any air leak into the pleural space requiring therapeutic intervention), hypotension (systolic blood pressure < 90 mm Hg sustained for longer than two minutes or requiring treatment with fluids or vasoactive drugs), bradycardia (heart rate < 50 beats per minute sustained for longer than one minute or requiring therapeutic intervention) and cardiac arrest (absence of effective cardiac output). SEARCH METHODS In this updated review, we searched the Cochrane Central Register of Controlled Trials (CENTRAL Issue 10, 2012, in The Cochrane Library; MEDLINE (Ovid SP, 1966 to November 2012); EMBASE (Ovid SP, 1980 to November 2012) and CINAHL (EBSCOhost,1982 to November 2012) for published studies. In our original review, we searched until May 2004.Grey literature was identified by searching conference proceedings and trial registries and by contacting experts in the field. SELECTION CRITERIA As in the original review, review authors selected randomized controlled trials that compared PLV with other forms of ventilation in adults (16 y of age or older) with ALI or ARDS, reporting one or more of the following: mortality; duration of mechanical ventilation, respiratory support, oxygen therapy, stay in the intensive care unit or stay in hospital; infection; long-term cognitive impairment or health-related quality of life; long-term lung function or cost. DATA COLLECTION AND ANALYSIS Two review authors independently evaluated the quality of the relevant studies and extracted the data from included studies. MAIN RESULTS In this updated review, one new eligible study was identified and included, yielding a total of two eligible studies (including a combined total of 401 participants). Of those 401 participants, 170 received 'high'-dose partial liquid ventilation (i.e. a mean dose of at least 20 mL/kg), 99 received 'low-dose' partial liquid ventilation (i.e. a dose of 10 mL/kg) and 132 received conventional mechanical ventilation (CMV). Pooled estimates of effect were calculated for all those who received 'high'-dose PLV versus conventional ventilation. No evidence indicated that 'high'-dose PLV either reduced mortality at 28 d (risk ratio (RR) 1.21, 95% confidence interval (CI) 0.79 to 1.85, P = 0.37) or increased the number of days free of CMV at 28 d (mean difference (MD) -2.24, 95% CI -4.71 to 0.23, P = 0.08). The pooled estimate of effect for bradycardia in those who received PLV was significantly greater than in those who received CMV (RR 2.51, 95% CI 1.31 to 4.81, P = 0.005). Pooled estimates of effect for the following adverse events- hypoxia, pneumothorax, hypotension and cardiac arrest- all showed a nonsignificant trend towards a higher occurrence of these events in those treated with PLV. Because neither eligible study addressed morbidity or mortality beyond 28 d, it was not possible to determine the effect of PLV on these outcomes. AUTHORS' CONCLUSIONS No evidence supports the use of PLV in ALI or ARDS; some evidence suggests an increased risk of adverse events associated with its use.
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10
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Neubauer AM, Sim H, Winter PM, Caruthers SD, Williams TA, Robertson JD, Sept D, Lanza GM, Wickline SA. Nanoparticle pharmacokinetic profiling in vivo using magnetic resonance imaging. Magn Reson Med 2009; 60:1353-61. [PMID: 19025903 DOI: 10.1002/mrm.21795] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Contrast agents targeted to molecular markers of disease are currently being developed with the goal of identifying disease early and evaluating treatment effectiveness using noninvasive imaging modalities such as MRI. Pharmacokinetic profiling of the binding of targeted contrast agents, while theoretically possible with MRI, has thus far only been demonstrated with more sensitive imaging techniques. Paramagnetic liquid perfluorocarbon nanoparticles were formulated to target alpha(v)beta(3)-integrins associated with early atherosclerosis in cholesterol-fed rabbits to produce a measurable signal increase on magnetic resonance images after binding. In this work, we combine quantitative information of the in vivo binding of this agent over time obtained by means of MRI with blood sampling to derive pharmacokinetic parameters using simultaneous and individual fitting of the data to a three compartment model. A doubling of tissue exposure (or area under the curve) is obtained with targeted as compared to control nanoparticles, and key parameter differences are discovered that may aid in development of models for targeted drug delivery.
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Affiliation(s)
- Anne M Neubauer
- Consortium for Translational Research in Advanced Imaging and Nanomedicine, Washington University, St Louis, Missouri 63108, USA
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11
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Wolfson MR, Hirschl RB, Jackson JC, Gauvin F, Foley DS, Lamm WJE, Gaughan J, Shaffer TH. Multicenter comparative study of conventional mechanical gas ventilation to tidal liquid ventilation in oleic acid injured sheep. ASAIO J 2008; 54:256-69. [PMID: 18496275 DOI: 10.1097/mat.0b013e318168fef0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
We performed a multicenter study to test the hypothesis that tidal liquid ventilation (TLV) would improve cardiopulmonary, lung histomorphological, and inflammatory profiles compared with conventional mechanical gas ventilation (CMV). Sheep were studied using the same volume-controlled, pressure-limited ventilator systems, protocols, and treatment strategies in three independent laboratories. Following baseline measurements, oleic acid lung injury was induced and animals were randomized to 4 hours of CMV or TLV targeted to "best PaO2" and PaCO2 35 to 60 mm Hg. The following were significantly higher (p < 0.01) during TLV than CMV: PaO2, venous oxygen saturation, respiratory compliance, cardiac output, stroke volume, oxygen delivery, ventilatory efficiency index; alveolar area, lung % gas exchange space, and expansion index. The following were lower (p < 0.01) during TLV compared with CMV: inspiratory and expiratory pause pressures, mean airway pressure, minute ventilation, physiologic shunt, plasma lactate, lung interleukin-6, interleukin-8, myeloperoxidase, and composite total injury score. No significant laboratories by treatment group interactions were found. In summary, TLV resulted in improved cardiopulmonary physiology at lower ventilatory requirements with more favorable histological and inflammatory profiles than CMV. As such, TLV offers a feasible ventilatory alternative as a lung protective strategy in this model of acute lung injury.
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Affiliation(s)
- Marla R Wolfson
- Department of Physiology, Temple University School of Medicine, Philadelphia, PA 19140, USA
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12
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Hagerty RD, Phelan MP, Morrison SC, Hatem SF. Radiographic detection of perflubron fluoromediastinum and fluororetroperitoneum 9 years after partial liquid ventilation. Emerg Radiol 2007; 15:71-5. [PMID: 17972121 DOI: 10.1007/s10140-007-0673-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Accepted: 08/30/2007] [Indexed: 10/22/2022]
Abstract
A 17-year-old patient presented, after a motor vehicle collision, with right hip pain and unusual radiographs of the chest and pelvis. Multiple radiopacities obscured detail. These partly obscured and distracted attention from a right acetabular fracture. The etiology was persistent perflubron 9 years after partial liquid ventilation for acute respiratory distress syndrome. Persistence of perflubron beyond 138 days has not been previously reported. We review the imaging appearance of perflubron and the mechanism likely related to its distribution and persistence in this case, and emphasize the importance of obtaining clinical history and avoiding distraction when faced with unusual radiographic findings.
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Affiliation(s)
- R Daniel Hagerty
- Department of Emergency Medicine, Cleveland Clinic, Cleveland, OH, USA
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13
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Abstract
Drug delivery to the diseased lung is hindered by the buildup of fluid and shunting of blood flow away from the site of injury. The use of perfluorocarbon compounds (PFCs) as drug delivery vehicles has been proposed to overcome these obstacles. This drug delivery approach is based on the unique properties of PFCs. For example, PFCs can homogeneously fill the lung and recruit airways by replacing edematous fluid. Analogously, drugs administered with a PFC vehicle are expected to be homogeneously distributed throughout the lung. At the same time, intrapulmonary administration of the drug will achieve higher drug concentrations in the lung than conventional approaches, while reducing systemic exposure. Unfortunately, PFCs are poor solvents for typical drug molecules. To overcome this obstacle, several approaches, such as dispersions, prodrugs, solubilizing agents and (micro)emulsions, are under investigation to develop homogeneous PFC-drug mixtures suitable for intrapulmonary administration.
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Affiliation(s)
- Hans-Joachim Lehmler
- Research Scientist, University of Iowa, Department of Occupational and Environmental Health, Iowa City, IA 52242, USA.
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14
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Tiruvoipati R, Balasubramanian SK, Entwisle JJ, Firmin RK, Peek GJ. Pseudocalcification on chest CT scan. Br J Radiol 2007; 80:e125-7. [PMID: 17704305 DOI: 10.1259/bjr/61486305] [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] [Indexed: 02/05/2023] Open
Abstract
Liquid ventilation with perfluorocarbons is used in severe respiratory failure that cannot be managed by conventional methods. Very little is known about the use of liquid ventilation in paediatric patients with respiratory failure and there are no reports describing the distribution and excretion of perfluorocarbons in paediatric patients with severe respiratory failure. The aim of this report is to highlight the prolonged retention of perfluorocarbons in a paediatric patient, mimicking pulmonary calcification and misleading the interpretation of the chest CT scan. A 10-year-old girl was admitted to our intensive care unit with severe respiratory failure due to miliary tuberculosis. Extracorporeal membrane oxygenation (ECMO) was used to support gas exchange and partial liquid ventilation (PLV) with perfluorodecalin was used to aid in oxygenation, lavage the lungs and clear thick secretions. The patient developed a pneumothorax (fluorothorax) on the next day and PLV was discontinued. Multiple bronchoalveolar lavages were performed to clear thick secretions. With no improvement in lung function over the next month a CT scan of the chest was performed. This revealed extensive pulmonary fibrosis and multiple high attenuation lesions suggestive of pulmonary calcification. To exclude perfluorodecalin as the cause for high attenuation lesions, a sample of perfluorodecalin was scanned to estimate the Hounsfield unit density, which was similar to the density of high attenuation lesions on chest CT scan. High-density opacification should be interpreted with caution, especially following liquid ventilation.
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Affiliation(s)
- R Tiruvoipati
- Department of ECMO and Cardiac Surgery, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
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15
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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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Davies MW, Fraser JF. Partial liquid ventilation for preventing death and morbidity in adults with acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev 2004:CD003707. [PMID: 15495062 DOI: 10.1002/14651858.cd003707.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Acute lung injury (ALI), and acute respiratory distress syndrome (ARDS), are syndromes of severe respiratory failure. Adults with ALI or ARDS have high mortality and significant morbidity. Partial liquid ventilation (PLV) may be better (i.e., cause less lung damage) for these patients than other forms of respiratory support. Uncontrolled studies in adults have shown improvement in gas exchange and lung compliance with partial liquid ventilation. OBJECTIVES To assess whether partial liquid ventilation reduces morbidity and mortality in adults with ALI or ARDS. SEARCH STRATEGY We searched The Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library Issue 2, 2004; MEDLINE (1966 to May 2004); and CINAHL (1982 to May 2004); intensive care journals and conference proceedings; reference lists and unpublished literature. SELECTION CRITERIA Randomized controlled trials which compared partial liquid ventilation with other forms of ventilation, in adults (16 years old or greater) with ALI or ARDS, reporting one or more of the following: mortality; duration of mechanical ventilation, respiratory support, oxygen therapy, stay in the intensive care unit, or stay in hospital; infection; long term cognitive impairment or health related quality of life; long term lung function; or cost. DATA COLLECTION AND ANALYSIS Two reviewers independently evaluated the quality of the relevant studies and extracted the data from the included studies. MAIN RESULTS Problems with the inadequacy of the primary report of the one included study do not allow us to report any quantitative results for patients with ALI or ARDS. The only outcome we considered to be of clinical significance and reported for all enrolled patients (i.e., patients with ALI and ARDS and less severe respiratory insufficiency) was 28 day mortality. There was no statistically significant difference between groups for this outcome with a relative risk for 28 day mortality in the PLV group of 1.15 (95% confidence intervals of 0.64 to 2.10). REVIEWERS' CONCLUSIONS There is no evidence from randomized controlled trials to support or refute the use of partial liquid ventilation in adults with ALI or ARDS; adequately powered, high quality randomized controlled trials are still needed to assess its efficacy. Clinically relevant outcome measures should be assessed (especially mortality at discharge and later, duration of respiratory support and hospital stay, and long term cognitive and quality of life outcomes) and the studies should be published in full.
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Affiliation(s)
- M W Davies
- Grantley Stable Neonatal Unit, Royal Women's Hospital, Butterfield St, Herston, Brisbane, Queensland, Australia, 4029.
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Villamor E, Degraeuwe PLJ, De Mey JGR, Blanco CE. Vascular reactivity of pulmonary arteries from premature lambs subjected to liquid ventilation. Neonatology 2004; 84:172-8. [PMID: 12907853 DOI: 10.1159/000071953] [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: 11/19/2022]
Abstract
This study aimed to evaluate the effect of tidal liquid ventilation (TLV) and liquid assisted high frequency oscillatory ventilation (LA-HFOV) on the contractile and relaxing properties of fetal ovine pulmonary arteries. 0.85 term lambs were subjected, after surfactant instillation, to 5 h of TLV or LA-HFOV (5 ml.kg(-1) perfluorocarbon liquid). After euthanasia of the animals, intrapulmonary arteries (fourth branch) were dissected and mounted in a myograph for isometric tension recording. Arteries from unventilated age-matched fetuses were also studied. The contractions induced by K(+), and the thromboxane A(2) mimetic U46619 were not significantly different in the TLV and the LA-HFOV groups. Acetylcholine-induced relaxation was absent after TLV and LA-HFOV but present in unventilated animals. Sodium nitroprusside-induced relaxation was also similar after TLV and LA-HFOV, but reduced when the two groups were compared with unventilated fetuses. We conclude that after TLV and LA-HFOV the pulmonary arterial responses to receptor- and non receptor-mediated contraction and to endothelium-dependent and -independent relaxation were similar.
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Affiliation(s)
- Eduardo Villamor
- Department of Pediatrics, University Hospital Maastricht, Research Institute Growth and Development (GROW), University of Maastricht, P. Debyelaan 25, PO Box 5800, NL-6202 AZ Maastricht, The Netherlands.
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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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Schoof E, von der Hardt K, Kandler MA, Abendroth F, Papadopoulos T, Rascher W, Dötsch J. Aerosolized perfluorocarbon reduces adhesion molecule gene expression and neutrophil sequestration in acute respiratory distress. Eur J Pharmacol 2002; 457:195-200. [PMID: 12464366 DOI: 10.1016/s0014-2999(02)02665-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In acute respiratory distress syndrome, neutrophil migration into the lung plays a key role in the development of lung injury. To study the effect of different modes of ventilation with perfluorocarbon (FC77), intrapulmonary neutrophil accumulation and mRNA expression of E-selectin, P-selectin and intercellular adhesion molecule-1 (ICAM-1), mediating leukocyte sequestration, were measured in surfactant depleted piglets. After bronchoalveolar lavage, 20 animals either received aerosolized perfluorocarbon (Aerosol-PFC), partial liquid ventilation (PLV) with perfluorocarbon at functional residual capacity filling volume (FRC-PLV) or at low volume (LV-PLV) or intermittent mandatory ventilation (control). After 2 h of perfluorocarbon application, intermittent mandatory ventilation was continued for 6 h. In the Aerosol-PFC group, all measured adhesion molecules showed a significantly reduced gene expression compared to controls. FRC-PFC treatment was effective in significantly diminishing P-selectin and ICAM-1 mRNA expression. Relative lung tissue neutrophil counts were significantly reduced in the Aerosol-PFC and the FRC-PLV group. Treatment with aerosolized perfluorocarbon is at least as effective as partial liquid ventilation at FRC volume in reducing pulmonary adhesion molecule expression and neutrophil accumulation in acute respiratory distress syndrome.
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Affiliation(s)
- Ellen Schoof
- Klinik mit Poliklinik für Kinder und Jugendliche, Pathologisch-Anatomisches Institut der Friedrich-Alexander-Universität Erlangen-Nürnberg, Loschgestrasse 15, D-91054 Erlangen, Germany
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Weiss DJ, Baskin GB, Shean MK, Blanchard JL, Kolls JK. Use of perflubron to enhance lung gene expression: safety and initial efficacy studies in non-human primates. Mol Ther 2002; 5:8-15. [PMID: 11786040 DOI: 10.1006/mthe.2001.0507] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Use of perflubron (LiquiVent) and other perfluorochemical liquids during intratracheal administration of adenovirus and AAV vectors has been shown to improve total gene expression as well as distribution of expression throughout lungs of spontaneously breathing rodents. To determine if this method could be safely and easily extended to non-human primates, we carried out a pilot investigation in six spontaneously breathing rhesus macaques. Two animals received bronchoscopic administration of recombinant adenovirus vector (type 5 E1-deleted AdCMVlacZ, 4.6 x 10(10) plaque forming units/animal), two animals received vector followed by instillation of perflubron, and two animals received perflubron alone. Instillation of perflubron was well tolerated by the animals and, once recovered from anesthesia, all animals behaved and fed normally until lung harvest. Serial X-rays demonstrated that the perflubron had cleared from lungs of three animals by 48 hours after administration; the fourth animal had a small amount of residual perflubron. Apart from a mild elevation in hepatocellular enzymes, no significant abnormality was noted in complete blood count or serum electrolytes and chemistries. In animals receiving either vector alone or vector with perflubron, in situ beta-galactosidase expression was observed in a variety of cells including large airway, bronchiolar, and alveolar epithelial cells. In summary, use of perflubron was well tolerated in spontaneously breathing macaques. Further studies in larger numbers of animals will help assess the potential efficacy of perflubron for enhancing gene expression and elucidate effects on local and systemic inflammatory responses.
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Affiliation(s)
- Daniel J Weiss
- Pulmonary and Critical Care, Fred Hutchinson Cancer Research Center, Seattle, WA 98105, USA.
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