ObjectiveTo compare the effectiveness of perfluorocarbon-associated gas exchange to volume controlled positive pressure breathing in supporting gas exchange, lung mechanics, and survival in an acute lung injury model.DesignA prospective, randomized study.SettingA university medical school laboratory approved for animal research.SubjectsNeonatal piglets.InterventionsEighteen piglets were randomized to receive perfluorocarbon-associated gas exchange with perflubron (n equals 10) or volume controlled continuous positive pressure breathing (n equals 8) after acute lung injury was induced by oleic acid infusion (0.15 mL/kg iv).Measurements and Main ResultsArterial and venous blood gases, hemodynamics, and lung mechanics were measured every 15 mins during a 3-hr study period. All animals developed a metabolic and a respiratory acidosis during the infusion of oleic acid. Following randomization, the volume controlled positive pressure breathing group developed a profound acidosis (p less than .05), while pH did not change in the perfluorocarbon-associated gas exchange group. Within 15 mins of initiating perfluorocarbon-associated gas exchange, oxygenation increased from a PaO2of 52 plus minus 12 torr (6.92 plus minus 1.60 kPa) to 151 plus minus 93 torr (20.0 plus minus 12.4 kPa) and continued to improve throughout the study (p less than .05). Animals that received volume controlled positive pressure breathing remained hypoxic with no appreciable change in PaO2. Although both groups developed hypercarbia during oleic acid infusion, PaCO2steadily increased over time in the control group (p less than .01). Static lung compliance significantly increased postrandomization (60 mins) in the animals supported by perfluorocarbon-associated gas exchange (p less than .05), whereas it remained unchanged over time in the volume controlled positive pressure breathing group. However, survival was significantly higher in the perfluorocarbon-associated gas exchange group with eight (80%) of ten animals surviving the entire study period. Only two (25%) of the eight animals in the volume controlled positive pressure breathing group were alive at the end of the study period (log-rank statistic, p equals .013).ConclusionsPerfluorocarbon-associated gas exchange enhanced gas exchange, pulmonary mechanics, and survival in this model of acute lung injury.(Crit Care Med 1996; 24:466-474)