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 Citations (Scopus)

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

Fingerprint

Fluorocarbons
Adult Respiratory Distress Syndrome
Stomach
Gases
Respiration
Tracheostomy
Pressure
Lung
Liquid Ventilation
Functional Residual Capacity
Chloralose
Neuromuscular Blockade
Wounds and Injuries
Critical Care
Trachea
Mechanics
Medical Schools
Catheterization
Analysis of Variance
Healthy Volunteers

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

Cite this

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

Perfluorocarbon-associated gas exchange in gastric aspiration. / 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.

In: Critical Care Medicine, Vol. 22, No. 9, 1994, p. 1445-1452.

Research output: Contribution to journalArticle

Nesti, FD, Fuhrman, BP, Steinhorn, DM, Papo, MC, Hernan, LJ, Duffy, LC, Fisher, JE, Leach, CL, Paczan, PR & Burak, BA 1994, 'Perfluorocarbon-associated gas exchange in gastric aspiration', Critical Care Medicine, vol. 22, no. 9, pp. 1445-1452.
Nesti FD, Fuhrman BP, Steinhorn DM, Papo MC, Hernan LJ, Duffy LC et al. Perfluorocarbon-associated gas exchange in gastric aspiration. Critical Care Medicine. 1994;22(9):1445-1452.
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. / Perfluorocarbon-associated gas exchange in gastric aspiration. In: Critical Care Medicine. 1994 ; Vol. 22, No. 9. pp. 1445-1452.
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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.",
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AU - Nesti, F. D.

AU - Fuhrman, B. P.

AU - Steinhorn, D. M.

AU - Papo, M. C.

AU - Hernan, L. J.

AU - Duffy, L. C.

AU - Fisher, J. E.

AU - Leach, C. L.

AU - Paczan, P. R.

AU - Burak, B. A.

PY - 1994

Y1 - 1994

N2 - 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.

AB - 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.

KW - critical care

KW - disease models, animal

KW - lung

KW - oxygen

KW - perfluorocarbons

KW - pneumonia, aspiration

KW - positive-pressure ventilation

KW - pulmonary emergencies

KW - respiratory distress syndrome, adult

KW - respiratory mechanics

KW - ventilation

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