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Vol. 84, Issue 2, 624-640, February 1998
Departments of Physiology, Pediatrics, and Pathology, Temple University School of Medicine, and St. Christopher's Hospital for Children, Philadelphia, Pennsylvania 19140
Wolfson, Marla R., Nancy E. Kechner, Robert F. Roache,
Jean-Pierre DeChadarevian, Helena E. Friss, S. David Rubenstein, and
Thomas H. Shaffer. Perfluorochemical rescue after surfactant treatment: effect of perflubron dose and ventilatory frequency. J. Appl. Physiol. 84(2): 624-640, 1998.
To test the hypotheses that perfluorochemical (PFC) liquid
rescue after natural surfactant (SF) treatment would improve pulmonary
function and histology and that this profile would be influenced by PFC
dose or ventilator strategy, anesthetized preterm lambs
(n = 31) with respiratory distress
were studied using nonpreoxygenated perflubron. All animals received SF
at 1 h and were randomized at 2 h as follows and studied to 4 h postnatal age: 1) conventional
mechanical gas ventilation (n = 8),
2) 30 ml/kg perflubron with gas
ventilation [partial liquid ventilation (PLV)] at 60 breaths/min (n = 8),
3) 10 ml/kg perflubron with PLV at
60 breaths/min (n = 7), and
4) 10 ml/kg perflubron with PLV at
30 breaths/min (n = 8). All animals
tolerated instillation without additional cardiopulmonary instability.
All perflubron-rescued groups demonstrated sustained improvement in gas
exchange, respiratory compliance, and reduction in pressure requirements relative to animals receiving SF alone. Improvement was
directly related to perflubron dose and breathing frequency; peak
inspiratory pressure required to achieve physiological gas exchange was
lower in the higher-dose and -frequency groups, and mean airway
pressure was lower in the lower-frequency group. Lung expansion was
greater and evidence of barotrauma was less in the higher-dose and
-frequency group; regional differences in expansion were not different
as a function of dose but were greater in the lower-frequency group.
Regional differences in lung perflubron content were reduced in the
higher-dose and -frequency groups and greatest in the lower-dose and
-frequency group. The results suggest that, whereas PLV of the
SF-treated lung improves gas exchange and lung mechanics, the
protective benefits of perflubron in the lung may depend on dose and
ventilator strategy to optimize PFC distribution and minimize exposure
of the alveolar-capillary membrane to a gas-liquid interface.
lung histomorphology; pulmonary stability; ventilation strategy
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