Perfluorocarbon-associated gas exchange in gastric aspiration

F. D. Nesti, B. P. Fuhrman, D. M. Steinhorn, M. C. Papo, L. J. Hernan, L. C. Duffy, J. E. Fisher, C. L. Leach, P. R. Paczan, B. A. Burak

Research output: Contribution to journalArticle

108 Scopus citations

Abstract

Objectives: To 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). Design: Prospective, randomized, blinded, controlled study. Setting: A critical care research laboratory in a university medical school. Subjects: Fourteen healthy piglets. Interventions: Under 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 Results: There 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. Conclusions: In 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.

Original languageEnglish (US)
Pages (from-to)1445-1452
Number of pages8
JournalCritical Care Medicine
Volume22
Issue number9
StatePublished - 1994
Externally publishedYes

Keywords

  • critical care
  • disease models, animal
  • lung
  • oxygen
  • perfluorocarbons
  • pneumonia, aspiration
  • positive-pressure ventilation
  • pulmonary emergencies
  • respiratory distress syndrome, adult
  • respiratory mechanics
  • ventilation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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  • Cite this

    Nesti, F. D., Fuhrman, B. P., Steinhorn, D. M., Papo, M. C., Hernan, L. J., Duffy, L. C., Fisher, J. E., Leach, C. L., Paczan, P. R., & Burak, B. A. (1994). Perfluorocarbon-associated gas exchange in gastric aspiration. Critical Care Medicine, 22(9), 1445-1452.