Partial liquid ventilation with surfactant: effects on gas exchange and lung pathology in surfactant-depleted piglets.
OBJECTIVE
To evaluate the effects of 24 h partial liquid ventilation (PLV) with and without surfactant (S) treatment on gas exchange and lung injury in a newborn animal model of S deficiency.


METHODS
A prospective, controlled, in vivo animal laboratory study.


METHODS
Research laboratory in a university setting.


METHODS
Twenty-four pathogen-free, male piglets (mean weight 1.9 kg, age 1-3 days).


METHODS
The animals were randomised in four groups: PLV with FC-77 combined with conventional ventilation (PLV/CV) versus S + PLV/CV and PLV combined with high frequency oscillatory ventilation (PLV/HFOV) versus S + PLV/HFOV. The piglets were anaesthetised, intubated and instrumented with vascular catheters. Thirty minutes after lung injury had been induced with repeated saline lavage, S animals received natural S. Thirty minutes after surfactant substitution PLV with FC-77 was started. The oxygenation index (OI), PaO(2)/FIO(2) ratio, PaCO(2) and the ventilatory efficacy index were determined before and during PLV. After 24 h the lungs were removed for histopathological examination.


RESULTS
Within 60 min after the initiation of PLV, all animals demonstrated improvements of the OI and PaO(2)/FIO(2) ratio compared to the values after lung injury. However, at 18 and 24 h of PLV, the OI and PaO(2)/FIO(2) ratio were significantly worse in the S + PLV/CV and S + PLV/HFOV groups compared to the groups without S. PaCO(2) was higher at 18 and 24 h when S was used in PLV/HFOV (p < 0.05). A semi-quantitative lung injury score revealed most severe lung damage in the S + PLV/HFOV group. CONCLUSIONS++: The combination of S and PLV with FC-77 led to an impaired gas exchange and did not further protect the animal from lung injury.
Merz
U
U
Children's Hospital, Neonatal Intensive Care, Aachen University of Technology, Pauwelsstrasse 30, D-52074 Aachen, Germany. umerz@post.klinikum
Kellinghaus
M
M
Häusler
M
M
Pakrawan
N
N
Klosterhalfen
B
B
Hörnchen
H
H
D000818:Animals; D000831:Animals, Newborn; D005466:Fluorocarbons / Q000008:administration & dosage; D006439:Hemodynamics; D006612:High-Frequency Ventilation; D008297:Male; D011659:Pulmonary Gas Exchange; D011663:Pulmonary Surfactants / Q000008:administration & dosage* / Q000172:deficiency*; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000473:pathology* / Q000628:therapy; D013552:Swine
D005466:Fluorocarbons; D011663:Pulmonary Surfactants