Efficacy of partial liquid ventilation in improving acute lung injury induced by intratracheal acidified infant formula: Determination of optimal dose and positive end-expiratory pressure level
Efficacy of partial liquid ventilation in improving acute lung injury induced by intratracheal acidified infant formula: Determination of optimal dose and positive end-expiratory pressure level
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DOI：
10.1097/01.ccm.0000104954.22016.d2
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发表时间：
2004-01-01
影响因子：
8.8
通讯作者：
Obara, H
中科院分区：
文献类型：
--
作者：
Mikawa, K;Nishina, K;Obara, H
目标。氟碳部分液体通气治疗油酸或肺灌洗所致急性肺损伤效果良好。部分液体通气时呼气末正压（PEEP）可提高氟碳的通气效果。本研究的目的是评估部分液体通气是否可以修复气管内酸化婴儿配方奶粉引起的肺损伤，并确定最佳氟碳剂量和PEEP水平。设计：前瞻性、随机动物研究。环境：大学研究实验室。设置和主题。76只雄性麻醉兔干预。在研究1中，四组采用气管内酸化婴儿配方奶粉诱导急性肺损伤。接下来，三组分别接受10、15或20 mL/kg氟碳化合物，第四组采用常规气体通风。在研究2中，五组均诱导急性肺损伤。其中一组以5 cm H2O的正压通气，而其他四组则接受氟碳（15 mL/kg），并被分配到四种正压水平（5、7.5、10或12.5 cm H2O）中的一种。急性肺损伤后给予100%氧通气4小时。测量结果和主要结果：在研究1中，剂量为15和20 mL/kg的氟碳减少了肺白细胞隔离、水肿和中性粒细胞超氧化物的产生，导致氧合、肺力学和病理变化的类似改善。最高氟碳剂量导致气胸死亡。在研究2中，PEEP联合部分液体通气改善了气体交换、肺顺应性、肺水肿和组织学观察到的损伤。在10和12.5 cm H2O下PEEP的有益效果相似。12.5 cm H2O PEEP的不良反应包括气胸和血流动力学不稳定。氟碳和PEEP联合应用可改善酸化婴儿配方奶粉所致的生理、生化和组织学肺损伤。部分液体通气的有益效果部分是由于抑制肺中性粒细胞积聚和氟碳活化。本模型的最佳氟碳剂量和PEEP水平分别为15 mL/kg和10 cm H2O。
Objectives. Partial liquid ventilation with fluorocarbon was successfully used for acute lung injury induced by oleic acid or lung lavage. Positive end-expiratory pressure (PEEP) during partial liquid ventilation enhances the efficacy of fluorocarbon. The aim of the current study was to assess whether partial liquid ventilation can repair lung damage induced by intratracheal acidified infant formula and to determine the optimal fluorocarbon dose and PEEP level.Design: Prospective, randomized animal study.Setting: University research laboratory.Setting and Subjects. Seventy-six male anesthetized rabbitsInterventions. For study 1, acute lung injury was induced by intratracheal acidified infant formula in four groups. Next, three groups received 10, 15, or 20 mL/kg fluorocarbon, and the fourth group was conventionally gas ventilated. For study 2, acute lung injury was induced in five groups. One group was gas ventilated at a PEEP of 5 cm H2O, whereas the other four groups received fluorocarbon (15 mL/kg) and were assigned to one of four PEEP levels (5, 7.5, 10, or 12.5 cm H2O). The lungs were ventilated with 100% oxygen for 4 hrs after acute lung injury.Measurements and Main Results: In study 1, fluorocarbon at doses of 15 and 20 mL/kg attenuated lung leukosequestration and edema and superoxide production of neutrophils, resulting in similar improvements in oxygenation, lung mechanics, and pathologic changes. The highest fluorocarbon dose caused mortality from pneumothorax. In study 2, the combination of PEEP with partial liquid ventilation improved gas exchange, lung compliance, pulmonary edema, and histologically observed damage. The beneficial effects of PEEP at 10 and 12.5 cm H2O were similar. Adverse side effects of 12.5 cm H2O PEEP included pneumothorax and hemodynamic instability.Conclusions. The combination of fluorocarbon and PEEP improved the physiologic, biochemical, and histologic lung injury induced by acidified infant formula. The beneficial effects of partial liquid ventilation are due, in part, to inhibition of pulmonary neutrophil accumulation and activation with fluorocarbon. The optimal fluorocarbon dose and PEEP level in our model were 15 mL/kg and 10 cm H2O, respectively.