Perfluorocarbon‐associated gas exchange in gastric aspiration
作者:
FRANCES NESTI,
BRADLEY FUHRMAN,
DAVID STEINHORN,
MICHELE PAPO,
LYNN HERNAN,
LINDA DUFFY,
JOHN FISHER,
CORINNE LEACH,
PAMELA PACZAN,
BEVERLY BURAK,
期刊:
Critical Care Medicine
(OVID Available online 1994)
卷期:
Volume 22,
issue 9
页码: 1445-1452
ISSN:0090-3493
年代: 1994
出版商: OVID
关键词: respiratory distress syndrome, adult;pneumonia, aspiration;perfluorocarbons;ventilation;critical care;oxygen;disease models, animal;positive-pressure ventilation;respiratory mechanics;pulmonary emergencies;lung
数据来源: OVID
摘要:
ObjectivesTo test whether perfluorocarbon-associated gas exchange (gas ventilation of the perfluorocarbon-liquid filled lung) could support oxygenation better than conventional positive pressure breathing in a piglet model of gastric aspiration-induced adult respiratory distress syndrome (ARDS).DesignProspective, randomized, blinded, controlled study.SettingA critical care research laboratory in a university medical school.SubjectsFourteen healthy piglets.InterventionsUnder α-chloralose anesthesia and metocurine iodide neuromuscular blockade, 14 piglets underwent tracheostomy; central venous, systemic and pulmonary arterial catheterizations; and volume-regulated continuous positive-pressure breathing. Homogenized gastric aspirate (1 mL/kg) titrated to pH of 1.0 was instilled into the tracheostomy tube of each subject at 0 min to induce ARDS. Hemodynamics, lung mechanics, and gas exchange were evaluated every 30 mins for 6 hrs. Seven piglets were treated at 60 mins by tracheal instillation of perflubron, a volume selected to approximate normal functional residual capacity, and were supported by perfluorocarbon-associated gas exchange without modifying ventilatory settings. Perflubron was added to the trachea every hour to replace evaporative losses.Measurements and Main ResultsThere was a significant difference in oxygenation over time when tested by repeated-measures analysis of variance (F test = 8.78,p< .01). On further analysis, the differences were not significant from baseline to 2.5 hrs but became increasingly significant from 2.5 to 6 hrs after injury (p< .05) in the inflammatory phase of gastric aspiration-induced ARDS. Histologic evidence for ARDS in the treated group 6 hrs after injury was lacking.ConclusionsIn the piglet model, perfluorocarbon-associated gas exchange with perflubron facilitates oxygenation in the acute phase of gastric aspiration-induced inflammatory ARDS when compared with conventional positive-pressure breathing. Histologic and physiologic data suggest that perfluorocarbon-associated gas exchange with perflubron might prevent ARDS if instituted after aspiration in the time window before the acute inflammatory process is manifest. (Crit Care Med 1994; 22:1445–1452)
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