title: Liquid lung ventilation reduces neutrophil sequestration in a neonatal swine model of cardiopulmonary bypass.
abstract: OBJECTIVE
  Liquid lung ventilation has been demonstrated to improve cardiorespiratory function after cardiopulmonary bypass. We hypothesized that liquid lung ventilation (LLV) would decrease the pulmonary inflammatory response after cardiopulmonary bypass (CPB).
  
  
  METHODS
  Prospective, randomized, experimental, controlled, nonblinded study.
  
  
  METHODS
  Animal research laboratory at a university setting.
  
  
  METHODS
  A total of 24 neonatal piglets.
  
  
  METHODS
  After intubation with a cuffed endotracheal tube, swine were conventionally ventilated. After surgical cannulation, each piglet was placed on conventional nonpulsatile CPB and cooled to 18 degrees C (64.4 degrees F). Subsequently, the animals were exposed to 90 mins of low-flow CPB (35 mL/kg/min). Animals were rewarmed to 37 degrees C (98.6 degrees F), removed from CPB, and ventilated for 90 min. Ten animals received conventional gas ventilation only (control), seven received initiation of LLV before CPB (prevention), and seven received initiation of LLV during the rewarming phase of CPB (treatment). After the animals were killed, the lungs were removed en bloc. The left lobe was dissected and formalin-fixed at 20 cm H2O overnight, followed by paraffin embedding. Sections were taken from the paraffin-embedded lungs. Neutrophil accumulation and lung injury were assessed by histochemical staining with leukocyte esterase and morphometrics, respectively. One hundred microscopic images were digitized from each tissue sample for lung morphometrics, and neutrophil counts were obtained from every fifth image.
  
  
  RESULTS
  Lung tissue sections showed a significantly lower number of neutrophils per alveolar area in the prevention and treatment groups than in the control group (control 681 +/- 65, prevention 380 +/- 49, treatment 412 +/- 101 neutrophils per alveolar area [cells/mm2]; p <.05 for both prevention and treatment compared with control). There were no differences in lung injury as assessed with morphometrics or hemodynamic measurements between any of the three groups.
  
  
  CONCLUSIONS
  The data suggest that LLV reduces the CPB-induced neutrophil sequestration in the pulmonary parenchyma independent of its effects on the circulatory physiology or evidence of early lung injury.
authors.affiliation: Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Williams
authors.forename: S E
authors.initials: SE
authors.lastname: Welty
authors.forename: R S
authors.initials: RS
authors.lastname: Geske
authors.forename: C L
authors.initials: CL
authors.lastname: Hubble
authors.forename: D M
authors.initials: DM
authors.lastname: Craig
authors.forename: G
authors.initials: G
authors.lastname: Quick
authors.forename: J N
authors.initials: JN
authors.lastname: Meliones
authors.forename: I M
authors.initials: IM
authors.lastname: Cheifetz
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D002265:Carboxylic Ester Hydrolases / Q000378:metabolism; D002315:Cardiopulmonary Bypass; D005466:Fluorocarbons / Q000627:therapeutic use*; D021061:Liquid Ventilation; D008168:Lung / Q000201:enzymology / Q000378:metabolism* / Q000473:pathology; D009504:Neutrophils / Q000378:metabolism*; D013552:Swine
chemical_list: D005466:Fluorocarbons; C021443:leukocyte esterase; D002265:Carboxylic Ester Hydrolases