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Zobel, G; Rödl, S; Urlesberger, B; Dacar, D; Trafojer, U; Trantina, A.
The effect of positive end-expiratory pressure during partial liquid ventilation in acute lung injury in piglets.
CRIT CARE MED 1999 27: 1934-1939. Doi: 10.1097%2F00003246-199909000-00036 [OPEN ACCESS]
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Leading authors Med Uni Graz: Zobel Gerfried
Co-authors Med Uni Graz: Dacar Drago; Roedl Siegfried; Urlesberger Berndt; Yates Ameli
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Abstract:: OBJECTIVES: To investigate the effects of positive end-expiratory pressure (PEEP) application during partial liquid ventilation (PLV) on gas exchange, lung mechanics, and hemodynamics in acute lung injury. DESIGN: Prospective, randomized, experimental study. SETTING: University research laboratory. SUBJECTS: Six piglets weighing 7 to 12 kg. INTERVENTIONS: After induction of anesthesia, tracheostomy, and controlled mechanical ventilation, animals were instrumented with two central venous catheters, a pulmonary artery catheter and two arterial catheters, and an ultrasonic flow probe around the pulmonary artery. Acute lung injury was induced by the infusion of oleic acid (0.08 mL/kg) and repeated lung lavage procedures with 0.9% sodium chloride (20 mL/kg). The protocol consisted of four different PEEP levels (0, 5, 10, and 15 cm H2O) randomly applied during PLV. The oxygenated and warmed perfluorocarbon liquid (30 mL/kg) was instilled into the trachea over 5 mins without changing the ventilator settings. MEASUREMENTS AND MAIN RESULTS: Airway pressures, tidal volumes, dynamic and static pulmonary compliance, mean and expiratory airway resistances, and arterial blood gases were measured. In addition, dynamic pressure/volume loops were recorded. Hemodynamic monitoring included right atrial, mean pulmonary artery, pulmonary capillary wedge, and mean systemic arterial pressures and continuous flow recording at the pulmonary artery. The infusion of oleic acid combined with two to five lung lavage procedures induced a significant reduction in PaO2/FI(O2) from 485 +/- 28 torr (64 +/- 3.6 kPa) to 68 +/- 3.2 torr (9.0 +/- 0.4 kPa) (p < .01) and in static pulmonary compliance from 1.3 +/- 0.06 to 0.67 +/- 0.04 mL/cm H2O/kg (p < .01). During PLV, PaO2/FI(O2) increased significantly from 68 +/- 3.2 torr (8.9 +/- 0.4 kPa) to >200 torr (>26 kPa) (p < .01). The highest PaO2 values were observed during PLV with PEEP of 15 cm H2O. Deadspace ventilation was lower during PLV when PEEP levels of 10 to 15 cm H2O were applied. There were no differences in hemodynamic data during PLV with PEEP levels up to 10 cm H2O. However, PEEP levels of 15 cm H2O resulted in a significant decrease in cardiac output. Dynamic pressure/volume loops showed early inspiratory pressure spikes during PLV with PEEP levels of 0 and 5 cm H2O. CONCLUSIONS: Partial liquid ventilation is a useful technique to improve oxygenation in severe acute lung injury. The application of PEEP during PLV further improves oxygenation and lung mechanics. PEEP levels of 10 cm H2O seem to be optimal to improve oxygenation and lung mechanics.
Find related publications in this database (using NLM MeSH Indexing): Analysis of Variance -; Animals -; Emulsions - administration and dosage; Fluorocarbons - administration and dosage; Hemodynamic Processes - administration and dosage; Positive-Pressure Respiration - methods; Prospective Studies - methods; Pulmonary Gas Exchange - methods; Random Allocation - methods; Research Support, Non-U.S. Gov't - methods; Respiratory Distress Syndrome, Adult - therapy; Respiratory Mechanics - therapy; Swine - therapy
Find related publications in this database (Keywords): Acute Respiratory Distress Syndrome; Mechanical Ventilation; Partial Liquid Ventilation; Positive End-Expiratory Pressure; Oxygenation; Lung Mechanics; Hemodynamics