Journal of Applied Physiology AJP: Lung Cellular and Molecular Physiology
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J Appl Physiol (May 16, 2003). doi:10.1152/japplphysiol.00598.2002
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Submitted on July 8, 2002
Accepted on May 6, 2003

Extended High Frequency Partial Liquid Ventilation In Lung Injury: Gas Exchange, Injury Quantification, and Vapor Loss

Allan Doctor1*, Eman Al-Khadra2, Puay Tan3, Kenneth W Watson2, Diana L Deisen4, Lisa J Workman1, John E Thompson3, Charles E Rose5, and John H Arnold2

1 Division of Pediatric Critical Care, University of Virginia, Charlottesville, VA, USA
2 Department of Anesthesia, Children's Hospital & Harvard Medical School, Boston, MA, USA
3 Department of Pathology, Children's Hospital & Harvard Medical School, Boston, MA, USA
4 School of Medicine, University of Virginia, Charlottesville, VA, USA
5 Division of Pulmonary and Critical Care, University of Virginia, Charlottesville, VA, USA

* To whom correspondence should be addressed. E-mail: ad4j{at}virginia.edu.

High frequency oscillatory ventilation (HFOV) 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 hours of HFO-PLV. Following saline lavage lung injury, 15 swine were rescued with HFOV (n=5), or in addition, received 10 cc/kg PFB delivered to dependent lung, (n=5, PLVC), or 10 cc/kg distributed uniformly within the lung (n=5, PLVU). In the PLVC group, PFB vapor loss was replaced. ANOVA revealed an unsustained improvement in oxygenation index in the PLVU group (p=0.04); the reduction in OI correlated with PFB losses. While tissue myeloperoxidase activity was reduced globally by HFOPLV (P < 0.01), and regional lung injury scores (LIS) in dependent lung were improved (p=0.05), global LIS were improved by HFOPLV (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 HFOPLV and it appears that uniform intrapulmonary PFB distribution optimized gas exchange during HFOPLV; additionally, monitoring PFB evaporative loss appears necessary to stabilize intrapulmonary PFB volume.




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