title: Extended high-frequency partial liquid ventilation in lung injury: gas exchange, injury quantification, and vapor loss.
abstract: High-frequency oscillatory ventilation with perflubron (PFB) reportedly improves pulmonary mechanics and gas exchange and attenuates lung injury. We explored PFB evaporative loss kinetics, intrapulmonary PFB distribution, and dosing strategies during 15 h of high-frequency oscillation (HFO)-partial liquid ventilation (PLV). After saline lavage lung injury, 15 swine were rescued with high-frequency oscillatory ventilation (n = 5), or in addition received 10 ml/kg PFB delivered to dependent lung [n = 5, PLV-compartmented (PLV(C))] or 10 ml/kg distributed uniformly within the lung [n = 5, PLV(U)]. In the PLV(C) group, PFB vapor loss was replaced. ANOVA revealed an unsustained improvement in oxygenation index in the PLV(U) group (P = 0.04); the reduction in oxygenation index correlated with PFB losses. Although tissue myeloperoxidase activity was reduced globally by HFO-PLV (P < 0.01) and regional lung injury scores (lung injury scores) in dependent lung were improved (P = 0.05), global lung injury scores were improved by HFO-PLV (P < 0.05) only in atelectasis, edema, and alveolar distension but not in cumulative score. In our model, markers of inflammation and lung injury were attenuated by HFO-PLV, and it appears that uniform intrapulmonary PFB distribution optimized gas exchange during HFO-PLV; additionally, monitoring PFB evaporative loss appears necessary to stabilize intrapulmonary PFB volume.
authors.affiliation: Division of Pediatric Critical Care, University of Virginia, Charlottesville, VA 22908-0386, USA. ad4j@virginia.edu
authors.forename: Allan
authors.initials: A
authors.lastname: Doctor
authors.forename: Eman
authors.initials: E
authors.lastname: Al-Khadra
authors.forename: Puay
authors.initials: P
authors.lastname: Tan
authors.forename: Kenneth F
authors.initials: KF
authors.lastname: Watson
authors.forename: Diana L
authors.initials: DL
authors.lastname: Diesen
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Workman
authors.forename: John E
authors.initials: JE
authors.lastname: Thompson
authors.forename: Charles E
authors.initials: CE
authors.lastname: Rose
authors.forename: John H
authors.initials: JH
authors.lastname: Arnold
mesh_terms: D000465:Algorithms; D000818:Animals; D002302:Cardiac Output / Q000502:physiology; D005466:Fluorocarbons; D006439:Hemodynamics / Q000502:physiology; D006454:Hemoglobins / Q000378:metabolism; D006612:High-Frequency Ventilation; D006842:Hydrocarbons, Brominated; D021061:Liquid Ventilation; D008168:Lung / Q000201:enzymology / Q000473:pathology; D055370:Lung Injury; D009195:Peroxidase / Q000378:metabolism; D011652:Pulmonary Circulation / Q000502:physiology; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D013552:Swine; D014655:Vascular Resistance / Q000502:physiology
chemical_list: D005466:Fluorocarbons; D006454:Hemoglobins; D006842:Hydrocarbons, Brominated; D009195:Peroxidase; C003072:perflubron