Partial liquid ventilation in premature lambs with respiratory distress syndrome

Efficacy and compatibility with exogenous surfactant

Corinne Lowe Leach, Bruce Holm, Frederick C. Morin, Bradley P. Fuhrman, Michele C. Papo, David Steinhorn, Lynn J. Hernan

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

Objective: To determine the efficacy of partial liquid ventilation (PLV) by means of a medical-grade perfluorochemical liquid, perflubron (LiquiVent), in premature lambs with respiratory distress syndrome (RDS). Further, to determine the compatibility of perflubron with exogenous surfactant both in vitro and in vivo during PLV. Design: Prospective, randomized, controlled study, with in vitro open comparison. Subjects: Twenty-two premature lambs with RDS. Interventions: In vitro assays were conducted on three exogenous surfactants before and after combination with perflubron. We studied four groups of lambs, which received one of the following treatment strategies: conventional mechanical ventilation (CMV); surfactant (Exosurf) plus CMV; PLV; or surfactant plus PLV. Measurements and main results: In vitro surface tension, measured for three exogenous surfactants, was unchanged in each animal after exposure to perflubron. Lung mechanics and arterial blood gases were serially measured. All animals treated with PLV survived the 5 hours of experiment without complication; several animals treated with CMV died. During CMV, all animals had marked hypoxemia and hypercapnia. During PLV, arterial oxygen tension increased sixfold to sevenfold within minutes of initiation, and this increase was sustained; arterial carbon dioxide tension decreased to within the normal range. Compliance increased fourfold to fivefold during PLV compared with CMV. Tidal volumes were increased during PLV, with lower mean airway pressure. Resistance was similar for both CMV and PLV; there was no difference with surfactant treatment. Conclusions: We conclude that PLV with perflubron improves lung mechanics and gas exchange in premature lambs with RDS, that PLV is compatible with exogenous surfactant therapy, and that, as a treatment for RDS in this model, PLV is superior to the surfactant studied. (J PEDIATR 1995;126:412-20).

Original languageEnglish (US)
Pages (from-to)412-420
Number of pages9
JournalThe Journal of Pediatrics
Volume126
Issue number3
DOIs
StatePublished - 1995
Externally publishedYes

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Liquid Ventilation
Surface-Active Agents
Artificial Respiration
Mechanics
Gases
Lung
Surface Tension
Hypercapnia
Tidal Volume
Therapeutics
Carbon Dioxide

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Partial liquid ventilation in premature lambs with respiratory distress syndrome : Efficacy and compatibility with exogenous surfactant. / Leach, Corinne Lowe; Holm, Bruce; Morin, Frederick C.; Fuhrman, Bradley P.; Papo, Michele C.; Steinhorn, David; Hernan, Lynn J.

In: The Journal of Pediatrics, Vol. 126, No. 3, 1995, p. 412-420.

Research output: Contribution to journalArticle

Leach, Corinne Lowe ; Holm, Bruce ; Morin, Frederick C. ; Fuhrman, Bradley P. ; Papo, Michele C. ; Steinhorn, David ; Hernan, Lynn J. / Partial liquid ventilation in premature lambs with respiratory distress syndrome : Efficacy and compatibility with exogenous surfactant. In: The Journal of Pediatrics. 1995 ; Vol. 126, No. 3. pp. 412-420.
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abstract = "Objective: To determine the efficacy of partial liquid ventilation (PLV) by means of a medical-grade perfluorochemical liquid, perflubron (LiquiVent), in premature lambs with respiratory distress syndrome (RDS). Further, to determine the compatibility of perflubron with exogenous surfactant both in vitro and in vivo during PLV. Design: Prospective, randomized, controlled study, with in vitro open comparison. Subjects: Twenty-two premature lambs with RDS. Interventions: In vitro assays were conducted on three exogenous surfactants before and after combination with perflubron. We studied four groups of lambs, which received one of the following treatment strategies: conventional mechanical ventilation (CMV); surfactant (Exosurf) plus CMV; PLV; or surfactant plus PLV. Measurements and main results: In vitro surface tension, measured for three exogenous surfactants, was unchanged in each animal after exposure to perflubron. Lung mechanics and arterial blood gases were serially measured. All animals treated with PLV survived the 5 hours of experiment without complication; several animals treated with CMV died. During CMV, all animals had marked hypoxemia and hypercapnia. During PLV, arterial oxygen tension increased sixfold to sevenfold within minutes of initiation, and this increase was sustained; arterial carbon dioxide tension decreased to within the normal range. Compliance increased fourfold to fivefold during PLV compared with CMV. Tidal volumes were increased during PLV, with lower mean airway pressure. Resistance was similar for both CMV and PLV; there was no difference with surfactant treatment. Conclusions: We conclude that PLV with perflubron improves lung mechanics and gas exchange in premature lambs with RDS, that PLV is compatible with exogenous surfactant therapy, and that, as a treatment for RDS in this model, PLV is superior to the surfactant studied. (J PEDIATR 1995;126:412-20).",
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T2 - Efficacy and compatibility with exogenous surfactant

AU - Leach, Corinne Lowe

AU - Holm, Bruce

AU - Morin, Frederick C.

AU - Fuhrman, Bradley P.

AU - Papo, Michele C.

AU - Steinhorn, David

AU - Hernan, Lynn J.

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N2 - Objective: To determine the efficacy of partial liquid ventilation (PLV) by means of a medical-grade perfluorochemical liquid, perflubron (LiquiVent), in premature lambs with respiratory distress syndrome (RDS). Further, to determine the compatibility of perflubron with exogenous surfactant both in vitro and in vivo during PLV. Design: Prospective, randomized, controlled study, with in vitro open comparison. Subjects: Twenty-two premature lambs with RDS. Interventions: In vitro assays were conducted on three exogenous surfactants before and after combination with perflubron. We studied four groups of lambs, which received one of the following treatment strategies: conventional mechanical ventilation (CMV); surfactant (Exosurf) plus CMV; PLV; or surfactant plus PLV. Measurements and main results: In vitro surface tension, measured for three exogenous surfactants, was unchanged in each animal after exposure to perflubron. Lung mechanics and arterial blood gases were serially measured. All animals treated with PLV survived the 5 hours of experiment without complication; several animals treated with CMV died. During CMV, all animals had marked hypoxemia and hypercapnia. During PLV, arterial oxygen tension increased sixfold to sevenfold within minutes of initiation, and this increase was sustained; arterial carbon dioxide tension decreased to within the normal range. Compliance increased fourfold to fivefold during PLV compared with CMV. Tidal volumes were increased during PLV, with lower mean airway pressure. Resistance was similar for both CMV and PLV; there was no difference with surfactant treatment. Conclusions: We conclude that PLV with perflubron improves lung mechanics and gas exchange in premature lambs with RDS, that PLV is compatible with exogenous surfactant therapy, and that, as a treatment for RDS in this model, PLV is superior to the surfactant studied. (J PEDIATR 1995;126:412-20).

AB - Objective: To determine the efficacy of partial liquid ventilation (PLV) by means of a medical-grade perfluorochemical liquid, perflubron (LiquiVent), in premature lambs with respiratory distress syndrome (RDS). Further, to determine the compatibility of perflubron with exogenous surfactant both in vitro and in vivo during PLV. Design: Prospective, randomized, controlled study, with in vitro open comparison. Subjects: Twenty-two premature lambs with RDS. Interventions: In vitro assays were conducted on three exogenous surfactants before and after combination with perflubron. We studied four groups of lambs, which received one of the following treatment strategies: conventional mechanical ventilation (CMV); surfactant (Exosurf) plus CMV; PLV; or surfactant plus PLV. Measurements and main results: In vitro surface tension, measured for three exogenous surfactants, was unchanged in each animal after exposure to perflubron. Lung mechanics and arterial blood gases were serially measured. All animals treated with PLV survived the 5 hours of experiment without complication; several animals treated with CMV died. During CMV, all animals had marked hypoxemia and hypercapnia. During PLV, arterial oxygen tension increased sixfold to sevenfold within minutes of initiation, and this increase was sustained; arterial carbon dioxide tension decreased to within the normal range. Compliance increased fourfold to fivefold during PLV compared with CMV. Tidal volumes were increased during PLV, with lower mean airway pressure. Resistance was similar for both CMV and PLV; there was no difference with surfactant treatment. Conclusions: We conclude that PLV with perflubron improves lung mechanics and gas exchange in premature lambs with RDS, that PLV is compatible with exogenous surfactant therapy, and that, as a treatment for RDS in this model, PLV is superior to the surfactant studied. (J PEDIATR 1995;126:412-20).

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