Low Tidal Volume Reduces Lung Inflammation Induced by Liquid Ventilation in Piglets With Severe Lung Injury

Jiang, Lijun; Feng, Hua; Chen, Xiaofan; Liang, Kaifeng; Ni, Chengyao

doi:10.1111/aor.12784

Cited by 6 publications

(3 citation statements)

References 19 publications

(24 reference statements)

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“…This latter finding strengthens a long-held belief within our team that total volume of PFC within the lungs must be tightly regulated. A recent study also suggested the use of lower volumes to prevent lung inflammation during TLV [ 22 ], in keeping with the overwhelming evidence that volutrauma is a significant contributor to ventilator-induced lung injury during conventional mechanical ventilation [ 23 ]. Thus, we hypothesize that uncontrolled volumes of PFC within the lung and/or high pause inspiratory and expiratory pressures may affect cardiac function, which may explain earlier findings of instability with less advanced TLV devices.…”

Section: Discussionmentioning

confidence: 81%

Assessing the impacts of total liquid ventilation on left ventricular diastolic function in a model of neonatal respiratory distress syndrome

et al. 2018

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BackgroundFilling the lung with dense liquid perfluorocarbons during total liquid ventilation (TLV) might compress the myocardium, a plausible explanation for the instability occasionally reported with this technique. Our objective is to assess the impacts of TLV on the cardiovascular system, particularly left ventricular diastolic function, in an ovine model of neonatal respiratory distress syndrome.MethodEight newborns lambs, 3.0 ± 0.4 days (3.2 ± 0.3kg) were used in this crossover experimental study. Animals were intubated, anesthetized and paralyzed. Catheters were inserted in the femoral and pulmonary arteries. A high-fidelity pressure catheter was inserted into the left ventricle. Surfactant deficiency was induced by repeated lung lavages with normal saline. TLV was then conducted for 2 hours using a liquid ventilator prototype. Thoracic echocardiography and cardiac output assessment by thermodilution were performed before and during TLV.ResultsLeft ventricular end diastolic pressure (LVEDP) (9.3 ± 2.1 vs. 9.2 ± 2.4mmHg, p = 0.89) and dimension (1.90 ± 0.09 vs. 1.86 ± 0.12cm, p = 0.72), negative dP/dt (-2589 ± 691 vs. -3115 ± 866mmHg/s, p = 0.50) and cardiac output (436 ± 28 vs. 481 ± 59ml/kg/min, p = 0.26) were not affected by TLV initiation. Left ventricular relaxation time constant (tau) slightly increased from 21.5 ± 3.3 to 24.9 ± 3.7ms (p = 0.03). Mean arterial systemic (48 ± 6 vs. 53 ± 7mmHg, p = 0.38) and pulmonary pressures (31.3 ± 2.5 vs. 30.4 ± 2.3mmHg, p = 0.61) were stable. As expected, the inspiratory phase of liquid cycling exhibited a small but significant effect on most variables (i.e. central venous pressure +2.6 ± 0.5mmHg, p = 0.001; LVEDP +1.18 ± 0.12mmHg, p<0.001).ConclusionsTLV was well tolerated in our neonatal lamb model of severe respiratory distress syndrome and had limited impact on left ventricle diastolic function when compared to conventional mechanical ventilation.

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Section: Discussionmentioning

confidence: 81%

Assessing the impacts of total liquid ventilation on left ventricular diastolic function in a model of neonatal respiratory distress syndrome

et al. 2018

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“…Jiang et al of Zhejiang University, Hangzhou, China investigated total liquid ventilation (TLV) in piglets with severe lung injury. Twelve piglets were randomly divided into two groups, TLV with high tidal volume (25 mL/kg) or with low tidal volume (6 mL/kg) for 240 min, respectively.…”

Section: Pulmonary Supportmentioning

confidence: 99%

Artificial Organs 2017: A Year in Review

Malchesky¹

2018

Artificial Organs

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In this Editor's Review, articles published in 2017 are organized by category and summarized. We provide a brief reflection of the research and progress in artificial organs intended to advance and better human life while providing insight for continued application of these technologies and methods. Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level." Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. Peer-reviewed Special Issues this year included contributions from the 12th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion edited by Dr. Akif Undar, Artificial Oxygen Carriers edited by Drs. Akira Kawaguchi and Jan Simoni, the 24th Congress of the International Society for Mechanical Circulatory Support edited by Dr. Toru Masuzawa, Challenges in the Field of Biomedical Devices: A Multidisciplinary Perspective edited by Dr. Vincenzo Piemonte and colleagues and Functional Electrical Stimulation edited by Dr. Winfried Mayr and colleagues. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.

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“…knowledge, the effect of tidal volume and respiratory rate on lung inflammation during TLV has not been thoroughly addressed. Jiang et al (2016) showed that a tidal volume of 6 mL/kg was associated with lower transcription and plasma protein levels of IL-6 and IL-8 in piglets, compared to a higher tidal volume of 25 mL/kg during TLV (Jiang et al, 2016). The authors, however, had to use extracorporeal carbon dioxide removal to achieve acceptable blood-gas exchange, thus preventing the need for high minute ventilation and its potential impact on VILI occurrence.…”

Section: Introductionmentioning

confidence: 99%

Effect of Low Versus High Tidal-Volume Total Liquid Ventilation on Pulmonary Inflammation

et al. 2020

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Animal experiments suggest that total liquid ventilation (TLV) induces less ventilatorinduced lung injury (VILI) than conventional mechanical gas ventilation. However, TLV parameters that optimally minimize VILI in newborns remain unknown. Our objective was to compare lung inflammation between low (L-V T) and high (H-V T) liquid tidal volume and evaluate impacts on the weaning process. Sixteen anesthetized and paralyzed newborn lambs were randomized in an L-V T group (initial tidal volume of 10 mL/kg at 10/min) and an H-V T group (initial tidal volume of 20 mL/kg at 5/min). Five unventilated newborn lambs served as controls. After 4 h of TLV in the supine position, the lambs were weaned in the prone position for another 4 h. The levels of respiratory support needed during the 4 h post-TLV were compared. The anterior and posterior lung regions were assessed by a histological score and real-time quantitative PCR for IL1B, IL6, and TNF plus 12 other exploratory VILI-associated genes. All but one lamb were successfully extubated within 2 h post-TLV (72 ± 26 min vs. 63 ± 25 min, p = 0.5) with similar FiO 2 at 4 h post-TLV (27 ± 6% vs. 33 ± 7%, p = 0.3) between the L-V T and H-V T lambs. No significant differences were measured in histological inflammation scores between L-V T and H-V T lambs, although lambs in both groups exhibited slightly higher scores than the control lambs. The L-V T group displayed higher IL1B mRNA expression than the H-V T group in both anterior (2.8 ± 1.5-fold increase vs. 1.3 ± 0.4-fold increase, p = 0.02) and posterior lung regions (3.0 ± 1.0-fold change increase vs. 1.1 ± 0.3-fold increase, p = 0.002), respectively. No significant differences were found in IL6 and TNF expression levels. Gene expression changes overall indicated that L-V T was associated with a qualitatively distinct inflammatory gene expression profiles compared to H-V T , which may indicate different clinical effects. In light of these findings, further mechanistic studies are warranted. In conclusion, we found no advantage of lower tidal volume use, which was in fact associated with a slightly unfavorable pattern of inflammatory gene expression.

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Low Tidal Volume Reduces Lung Inflammation Induced by Liquid Ventilation in Piglets With Severe Lung Injury

Cited by 6 publications

References 19 publications

Assessing the impacts of total liquid ventilation on left ventricular diastolic function in a model of neonatal respiratory distress syndrome

Assessing the impacts of total liquid ventilation on left ventricular diastolic function in a model of neonatal respiratory distress syndrome

Artificial Organs 2017: A Year in Review

Effect of Low Versus High Tidal-Volume Total Liquid Ventilation on Pulmonary Inflammation

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