Prevention of ventilator-induced lung injury with partial liquid ventilation

Background/Purpose: Pulmonary injury from mechanical ventilation has been a ttributed to application of excess alveolar pressure (barotrauma) or volume (volutrauma). The authors questioned whether partial liquid ventilation (g as ventilation of the perfluorocarbon filled lung, PLV) would reduce ventil ator-induced lung injury. Methods: A tracheostomy tube and carotid artery catheter were placed in ane sthetized Sprague-Dawley rats (500 +/- 50 g). Bovine serum albumin (BSA) la beled with Iodine (I) 125 was administered intraarterially. Ventilation wit h tidal volume (TV) of 5 mL/kg was initiated. The rats were then selected r andomly to a 30-minute experimental period of one of the following ventilat ion protocols: continued atraumatic gas ventilation (GV, TV, 5 mL/kg; n=10) ; atraumatic gas ventilation combined with intratracheal administration of 10 mL/kg perfluorocarbon (GV-PLV, TV, 5 mL/kg, n=10); barotrauma (BT, peak inspiratory pressure [PIP], 45 cm H2O; n=10); barotrauma with PLV (BT-PLV, PIP, 45 cm H2O; n= 8); volutrauma (VT, TV, 30 mL/kg; n= 8); or volutrauma w ith PLV (VT-PLV, TV, 30 mL/kg; n=10). Animals were killed and the amount of radiolabeled BSA in both lungs was measured and normalized to the counts i n 1 mL of blood from that animal (injury index). Data were analyzed by anal ysis of variance (ANOVA) with post-hoc t test comparison between groups. Results: There was a significant difference in the I-125-BSA injury index w hen all groups were compared (P<.001 by ANOVA). Post-hoc analysis showed a significant decrease in the injury index when comparing BT versus BT-PLV (P =.024) and VT versus VT-PLV (P=.014). Conclusion: I-125-BSA leak produced during high-pressure or high-volume mec hanical ventilation is reduced by partial liquid ventilation. J Pediatr Sur g 36:1333-1336. Copyright (C) 2001 by W.B. Saunders Company.