Cardiopulmonary interaction during partial liquid ventilation in surfactant-treated preterm lambs

Davidson, Alexander; Jl, Heckman; Rm, Donner; Tf, Miller; Shaffer, T. H.; Mr, Wolfson

doi:10.1007/s004310050786

Cited by 16 publications

(6 citation statements)

References 46 publications

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“…Data for the effect of PFC on pulmonary vascular and right ventricular pressure are controversial. For total liquid ventilation an increase in pulmonary vascular resistance and thus right ventricular afterload was found, but the results for partial liquid ventilation are less prominent [21,30].…”

Section: Discussionmentioning

confidence: 93%

Cerebral Oxygenation Is Affected by Filling Mode and Perfluorochemical Volume in Partial Liquid Ventilation of Healthy Piglets

Burkhardt

Proquitté²,

Krause³

et al. 2002

Neonatology

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Intrapulmonary administration of perfluorochemicals (PFC) has been suggested for reasons other than respiratory insufficiency. PFC application has been described to affect cerebral Hb concentration, however, data for healthy lungs are missing. Newborn piglets were randomized into 3 groups (30-ml slow-filling, 10-ml slow-filling and 30-ml rapid-filling), orally intubated and mechanically ventilated. Partial liquid ventilation (PLV) was initiated by filling the lung with PF5080 (10 or 30 ml/kg) at a rate of 1.5 ml/min (slow filling) or within 45 s (rapid filling). Vital signs, blood gases, tidal volume (VT) and changes in the cerebral concentration of oxygenated hemoglobin (HbO₂) and total Hb were determined for up to 20 min. Rapid administration of PFC caused an immediate drop in HbO₂, PaO₂ and VT. The concentration of oxygenated and total Hb increased thereafter and remained high. We found a slow increase in PaCO₂, HbO₂ and total Hb in the 30-ml slow-filling group, but almost no changes in the 10-ml slow filling group (except for a decrease in PaO₂). According to our data, PLV with 10 ml/kg should be preferred since cerebral alterations are minimal. If complete filling of the lung is needed PFC should be administered slowly to minimize side effects.

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Section: Discussionmentioning

confidence: 93%

Cerebral Oxygenation Is Affected by Filling Mode and Perfluorochemical Volume in Partial Liquid Ventilation of Healthy Piglets

Burkhardt

Proquitté²,

Krause³

et al. 2002

Neonatology

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“…With PLV there is the potential for a rise in intrathoracic pressure with the instillation of dense perfluorocarbon liquid into the lungs with an increase in central venous pressure and a decrease in cerebral blood flow, the opposite effect to that seen in this study. Also, PLV is known not to affect central venous pressure once it has been started [20,21] , although this has not been studied during perfluorocarbon liquid dosing. PLV redistributes pulmonary blood flow within the lungs [21] , and the possibility exists that an overall decrease in pulmonary vascular resistance may decrease right atrial pressures, increase cerebral perfusion pressure and increase cerebral blood flow.…”

Section: Discussionmentioning

confidence: 99%

Perfluorocarbon Dosing when Starting Partial Liquid Ventilation: Haemodynamics and Cerebral Blood Flow in Preterm Lambs

Davies

Dunster²,

Wilson

et al. 2009

Neonatology

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Background: Very preterm neonates can have severe lung disease and are prone to brain injury if cerebral blood flow fluctuates. Partial liquid ventilation (PLV) may benefit the lung disease, but it is unknown whether the administration of intratracheal perfluorocarbon when starting PLV affects haemodynamics or cerebral blood flow. Objectives: To determine if haemodynamics or cerebral blood flow are affected in preterm lambs receiving a dose of perfluorocarbon when starting PLV. Methods: Sixteen preterm lambs were randomised to either PLV or conventional mechanical ventilation. An intratracheal loading dose of 30 ml/kg of perfluorocarbon liquid (PLV group) or air (sham group) was instilled over 20 min. Data were collected continuously for 30 min from the start of dosing. Results: Cortical cerebral blood flow velocity, measured continuously with laser Doppler, was increased in the PLV group during the administration of perfluorocarbon and immediately thereafter (p = 0.0026); the highest mean increase in the PLV group was 27%. There was no difference in cortical cerebral blood flow variability (p = 0.96). There was a slightly lower mean arterial blood pressure in the PLV group; the heart rate did not differ between groups. The PaCO₂ was higher in the PLV group at 30 min – the difference between groups was not statistically significant (difference between means = 5.5 mm Hg, 95% confidence interval –2.7 to 13.7). Conclusions: Preterm lambs receiving a dose of tracheal perfluorocarbon at the start of PLV have an increased cortical cerebral blood flow velocity, but no change in cortical cerebral blood flow variability.

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“…107,141 During PLV in the premature lamb, lung compliance increased significantly, but left ventricular output, absolute pulmonary blood flow, ductal flow, systemic arterial pressure, heart rate, left ventricular ejection and shortening fraction, and velocity of circumferential fiber shortening remain unchanged, while meridional wall stress was reduced. 142 In vitro study of the isolated perfused neonatal piglet injured lung model demonstrated that PLV reduced or prevented an increase in PVR. 143 These studies suggest that improved gas exchange during PLV is related to enhanced mechanical stability of the lung, which may preserve pulmonary blood flow rather than alter central hemodynamics.…”

Section: Preclinical Studiesmentioning

confidence: 99%

Liquid-assisted ventilation: An alternative respiratory modality

1998

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Cardiopulmonary interaction during partial liquid ventilation in surfactant-treated preterm lambs

Abstract: Cardiac output and pulmonary blood flow do not change significantly during PLV and therefore do not appear to contribute to improved gas exchange. This stable cardiac performance occurs at lower wall stress and thereby more advantageous energetic conditions.

Cited by 16 publications

References 46 publications

Cerebral Oxygenation Is Affected by Filling Mode and Perfluorochemical Volume in Partial Liquid Ventilation of Healthy Piglets

Cerebral Oxygenation Is Affected by Filling Mode and Perfluorochemical Volume in Partial Liquid Ventilation of Healthy Piglets

Perfluorocarbon Dosing when Starting Partial Liquid Ventilation: Haemodynamics and Cerebral Blood Flow in Preterm Lambs

Liquid-assisted ventilation: An alternative respiratory modality

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