title: Effects on lung stress of position and different doses of perfluorocarbon in a model of ARDS.
abstract: We determined whether the combination of low dose partial liquid ventilation (PLV) with perfluorocarbons (PFC) and prone positioning improved lung function while inducing minimal stress. Eighteen pigs with acute lung injury were assigned to conventional mechanical ventilation (CMV) or PLV (5 or 10 ml/kg of PFC). Positive end-expiratory pressure (PEEP) trials in supine and prone positions were performed. Data were analyzed by a multivariate polynomial regression model. The interplay between PLV and position depended on the PEEP level. In supine PLV dampened the stress induced by increased PEEP during the trial. The PFC dose of 5 ml/kg was more effective than the dose 10 ml/kg. This effect was not observed in prone. Oxygenation was significantly higher in prone than in supine position mainly at lower levels of PEEP. In conclusion, MV settings should take both gas exchange and stress/strain into account. When protective CMV fails, rescue strategies combining prone positioning and PLV with optimal PEEP should improve gas exchange with minimal stress.
authors: Fundació Parc Taulí, Corporació Sanitària Parc Taulí, Sabadell, Spain; Institut de Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Campus d' Excelència Internacional, Bellaterra, Spain; Critical Care Center, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: jlopeza@tauli.cat.
authors: Josefina
authors: J
authors: López-Aguilar
authors: Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, Trieste University, Trieste, Italy.
authors: Umberto
authors: U
authors: Lucangelo
authors: CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; Dpto. Biologia Funcional, Universidad de Oviedo, Instituto Universitario de Oncologia del Principado de Asturias, Oviedo, Spain; Intensive Care Unit, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors: Guillermo M
authors: GM
authors: Albaiceta
authors: Pulmonary and Critical Care Department, St. Paul-Ramsey Medical Center, University of Minnesota, St. Paul, MN, USA.
authors: Avi
authors: A
authors: Nahum
authors: Clínica Bazterrica y Clínica Santa Isabel, Buenos Aires, Argentina.
authors: Gastón
authors: G
authors: Murias
authors: Laboratory of Experimental Pneumology, IDIBELL, L'Hospitalet, Spain.
authors: Rosario
authors: R
authors: Cañizares
authors: Fundació Parc Taulí, Corporació Sanitària Parc Taulí, Sabadell, Spain; Institut de Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Campus d' Excelència Internacional, Bellaterra, Spain.
authors: Joan Carles
authors: JC
authors: Oliva
authors: Laboratory of Experimental Pneumology, IDIBELL, L'Hospitalet, Spain.
authors: Pablo V
authors: PV
authors: Romero
authors: Fundació Parc Taulí, Corporació Sanitària Parc Taulí, Sabadell, Spain; Institut de Investigació i Innovació Parc Taulí, Universitat Autònoma de Barcelona, Campus d' Excelència Internacional, Bellaterra, Spain; Critical Care Center, Hospital de Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
authors: Lluís
authors: L
authors: Blanch
mesh_terms: D055371:Acute Lung Injury / Q000503:physiopathology / Q000628:therapy; D000818:Animals; D001784:Blood Gas Analysis; D002317:Cardiovascular Agents / Q000494:pharmacology; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D005466:Fluorocarbons / Q000494:pharmacology*; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D021061:Liquid Ventilation / Q000379:methods*; D008168:Lung / Q000187:drug effects* / Q000503:physiopathology*; D008297:Male; D009829:Oleic Acids / Q000494:pharmacology; D011175:Positive-Pressure Respiration; D016684:Prone Position / Q000502:physiology*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D013312:Stress, Physiological / Q000187:drug effects / Q000502:physiology; D016683:Supine Position / Q000502:physiology; D013552:Swine
chemical_list: D002317:Cardiovascular Agents; D005466:Fluorocarbons; D009829:Oleic Acids
keywords: ARDS; Lung recruitment; Partial liquid ventilation; Perfluorocarbon; Prone; Stress