Partial liquid ventilation in premature lambs with respiratory distress syndrome: efficacy and compatibility with exogenous surfactant.
OBJECTIVE
To determine the efficacy of partial liquid ventilation (PLV) by means of a medical-grade perfluorochemical liquid, perflubron (LiquiVent), in premature lambs with respiratory distress syndrome (RDS). Further, to determine the compatibility of perflubron with exogenous surfactant both in vitro and in vivo during PLV.


METHODS
Prospective, randomized, controlled study, with in vitro open comparison.


METHODS
Twenty-two premature lambs with RDS.


METHODS
In vitro assays were conducted on three exogenous surfactants before and after combination with perflubron. We studied four groups of lambs, which received one of the following treatment strategies: conventional mechanical ventilation (CMV); surfactant (Exosurf) plus CMV; PLV; or surfactant plus PLV.


RESULTS
In vitro surface tension, measured for three exogenous surfactants, was unchanged in each animal after exposure to perflubron. Lung mechanics and arterial blood gases were serially measured. All animals treated with PLV survived the 5 hours of experiment without complication; several animals treated with CMV died. During CMV, all animals had marked hypoxemia and hypercapnia. During PLV, arterial oxygen tension increased sixfold to sevenfold within minutes of initiation, and this increase was sustained; arterial carbon dioxide tension decreased to within the normal range. Compliance increased fourfold to fivefold during PLV compared with CMV. Tidal volumes were increased during PLV, with lower mean airway pressure. Resistance was similar for both CMV and PLV; there was no difference with surfactant treatment.


CONCLUSIONS
We conclude that PLV with perflubron improves lung mechanics and gas exchange in premature lambs with RDS, that PLV is compatible with exogenous surfactant therapy, and that, as a treatment for RDS in this model, PLV is superior to the surfactant studied.
Leach
C L
CL
Department of Pediatrics, Children's Hospital of Buffalo, State University of New York.
Holm
B
B
Morin
F C
FC
Fuhrman
B P
BP
Papo
M C
MC
Steinhorn
D
D
Hernan
L J
LJ
D000818:Animals; D000831:Animals, Newborn; D001688:Biological Products; D003131:Combined Modality Therapy; D004338:Drug Combinations; D004655:Emulsions; D005233:Fatty Alcohols / Q000627:therapeutic use; D005466:Fluorocarbons / Q000627:therapeutic use*; D006801:Humans; D006842:Hydrocarbons, Brominated; D007231:Infant, Newborn; D010100:Oxygen / Q000097:blood; D010767:Phosphorylcholine; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D011897:Random Allocation; D012121:Respiration, Artificial / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy / Q000628:therapy*; D012756:Sheep
D001688:Biological Products; D004338:Drug Combinations; D004655:Emulsions; D005233:Fatty Alcohols; D005466:Fluorocarbons; D006842:Hydrocarbons, Brominated; D011663:Pulmonary Surfactants; D010767:Phosphorylcholine; D011092:Polyethylene Glycols; C047049:dipalmitoylphosphatidylcholine, hexadecanol, tyloxapol drug combination; C003072:perflubron; C072197:beractant; D010100:Oxygen