title: Effects of single and multiple doses of perfluorocarbon in comparison with continuous partial liquid ventilation on gas exchange and lung pathology in newborn surfactant-depleted pigs.
abstract: OBJECTIVE
  To compare the efficacy of single, multiple, and continuous application of perfluorocarbon (PFC) FC-77 on gas exchange and lung pathology in a prolonged 24-hr study.
  
  
  METHODS
  Controlled animal trial.
  
  
  METHODS
  Research laboratory in a university setting.
  
  
  METHODS
  Twenty-one newborn piglets (mean weight 1.94 kg).
  
  
  METHODS
  After intubation and instrumentation, the anesthetized animals were randomized in three groups: a) animals receiving one 1-hr session of partial liquid ventilation (PLV) followed by 23 hrs of conventional ventilation (CV), designated as the single PLV (S-PLV) group; b) animals receiving multiple 1-hr sessions of PLV with intermittent CV, designated as the multiple PLV (M-PLV) group; and c) animals receiving continuous PLV over 24 hrs, designated as the continuous PLV (C-PLV) group. After lung injury was induced with repeated saline lavage, specific ventilatory treatment was initiated. The oxygenation index, Pao2/Fio2 ratio, and ventilatory efficacy index were determined before and after lung injury and during the 24-hr course. After 24 hrs, the lungs were removed for histopathologic examination.
  
  
  RESULTS
  Gas exchange variables improved within 60 mins in all groups after the initiation of the specific ventilatory treatment (p < .01). The best outcome was observed in the C-PLV group, which provided a continuously stable gas exchange over the 24-hr period. S-PLV initially improved gas exchange, but after 6 hrs all variables were impaired when compared with C-PLV (p < .01). M-PLV transiently improved gas exchange variables after each PFC application; however, M-PLV was associated with a significant deterioration of all pulmonary variables during the 24-hr course. The lungs of the animals in the M-PLV group demonstrated an increased lung injury score (p < .01) and increased morphometric values (p < .05) when compared with C-PLV.
  
  
  CONCLUSIONS
  In surfactant deficient lungs, single and multiple applications of PFC only transiently improved oxygenation. Multiple PFC fillings with intermittent gas ventilation led to a deterioration of gas exchange during the 24-hr study and severe lung damage. Continuous PLV provides the best gas exchange and the most favorable histopathologic outcome.
authors.affiliation: Children's Hospital, Neonatal Intensive Care, Aachen University of Technology, Pauwelsstr. 30, 52057 Aachen, Germany. umerz@post.klinikum.rwth-aachen.de
authors.forename: U
authors.initials: U
authors.lastname: Merz
authors.forename: B
authors.initials: B
authors.lastname: Klosterhalfen
authors.forename: M
authors.initials: M
authors.lastname: Kellinghaus
authors.forename: T
authors.initials: T
authors.lastname: Peschgens
authors.forename: S
authors.initials: S
authors.lastname: Pluschke
authors.forename: H
authors.initials: H
authors.lastname: Hoernchen
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001784:Blood Gas Analysis; D004195:Disease Models, Animal; D005466:Fluorocarbons / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D021061:Liquid Ventilation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D010100:Oxygen / Q000097:blood; D011659:Pulmonary Gas Exchange / Q000187:drug effects*; D011663:Pulmonary Surfactants / Q000172:deficiency*; D011897:Random Allocation; D012127:Respiratory Distress Syndrome, Newborn / Q000209:etiology / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D012965:Sodium Chloride; D013552:Swine; D007507:Therapeutic Irrigation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005466:Fluorocarbons; D011663:Pulmonary Surfactants; C429307:fluorocarbon 77; D012965:Sodium Chloride; D010100:Oxygen