title: Effects of respiratory rate and tidal volume on gas exchange in total liquid ventilation.
abstract: Using a rabbit model of total liquid ventilation (TLV), and in a corresponding theoretical model, we compared nine tidal volume-respiratory rate combinations to identify a ventilator strategy to maximize gas exchange, while avoiding choked flow, during TLV. Nine different ventilation strategies were tested in each animal (n = 12): low [LR = 2.5 breath/min (bpm)], medium (MR = 5 bpm), or high (HR = 7.5 bpm) respiratory rates were combined with a low (LV = 10 ml/kg), medium (MV = 15 ml/kg), or high (HV = 20 ml/kg) tidal volumes. Blood gases and partial pressures, perfluorocarbon gas content, and airway pressures were measured for each combination. Choked flow occurred in all high respiratory rate-high volume animals, 71% of high respiratory rate-medium volume (HRMV) animals, and 50% of medium respiratory rate-high volume (MRHV) animals but in no other combinations. Medium respiratory rate-medium volume (MRMV) resulted in the highest gas exchange of the combinations that did not induce choke. The HRMV and MRHV animals that did not choke had similar or higher gas exchange than MRMV. The theory predicted this behavior, along with spatial and temporal variations in alveolar gas partial pressures. Of the combinations that did not induce choked flow, MRMV provided the highest gas exchange. Alveolar gas transport is diffusion dominated and rapid during gas ventilation but is convection dominated and slow during TLV. Consequently, the usual alveolar gas equation is not applicable for TLV.
authors.affiliation: Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109, USA. joebull@umich.edu
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Bull
authors.forename: Stefano
authors.initials: S
authors.lastname: Tredici
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujioka
authors.forename: Eisaku
authors.initials: E
authors.lastname: Komori
authors.forename: James B
authors.initials: JB
authors.lastname: Grotberg
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Hirschl
mesh_terms: D000818:Animals; D004058:Diffusion; D005260:Female; D006439:Hemodynamics; D021061:Liquid Ventilation / Q000379:methods*; D008176:Lung Volume Measurements; D008297:Male; D011312:Pressure; D011650:Pulmonary Alveoli / Q000378:metabolism; D011659:Pulmonary Gas Exchange; D012123:Pulmonary Ventilation; D011817:Rabbits; D015656:Respiratory Mechanics; D013990:Tidal Volume; D016896:Treatment Outcome