Partial liquid ventilation and positive end-expiratory pressure reduce ventilator-induced lung injury in an ovine model of acute respiratory failure

Craig A. Reickert, Preston B. Rich, Stefania Crotti, Simon A. Mahler, Samir S. Awad, William R. Lynch, Kent J. Johnson, Ronald B. Hirschl

Research output: Contribution to journalArticle

Abstract

Objective: To examine the isolated and combined effects of positive end-expiratory pressure (PEEP) and partial liquid ventilation (PLV) on the development of ventilator-induced lung injury in an ovine model. Design: Prospective controlled animal study. Setting: University-based cardiovascular animal physiology laboratory. Subjects: Thirty-eight anesthetized supine sheep weighing 22.3 ± 2.2 kg. Interventions: Animals were ventilated for 6 hrs (respiratory rate, 15; F102, 1.0, inspiratory/expiratory ratio, 1:1) with one of five pressure-controlled strategies, expressed as peak inspiratory pressure (PIP)/PEEP: low-PIP, 25/5 cm H2O (n = 8); high-PIP, 50/5 cm H2O (n = 8); high-PIP-PLV, 50/5 cm H2O-PLV (n = 8); high-PEEP, 50/20 cm H2O (n = 7); and high-PEEP-PLV, 50/20 cm H2O-PLV (n = 7). Measurements and Main Results: Compared with the low-PIP control, high-PIP ventilation increased airleak, shunt, histologic evidence of lung injury, neutrophil infiltrates, and wet lung weight. Maintaining PEEP at 20 cm H2O or adding PLV reduced the development of physiologic shunt and dependent histologic injury indexes. Neither higher PEEP nor PLV reduced the high incidence of barotrauma observed in high-PIP animals. Conclusions: We conclude that application of PLV or PEEP at 20 cm H2O may improve gas exchange and afford lung protection from ventilator-induced lung injury during high-pressure mechanical ventilation in this model.

Original languageEnglish
Pages (from-to)182-189
Number of pages8
JournalCritical Care Medicine
Volume30
Issue number1
Publication statusPublished - 2002

Fingerprint

Liquid Ventilation
Ventilator-Induced Lung Injury
Positive-Pressure Respiration
Respiratory Insufficiency
Sheep
Pressure
Cardiovascular Physiological Phenomena
Barotrauma
Laboratory Animals
Lung Injury
Pulmonary Edema
Respiratory Rate
Artificial Respiration
Ventilation
Neutrophils
Gases

Keywords

  • Barotrauma
  • Fluorocarbons
  • Mechanical ventilators
  • Partial liquid ventilation
  • Respiratory insufficiency
  • Ventilator-induced lung injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Partial liquid ventilation and positive end-expiratory pressure reduce ventilator-induced lung injury in an ovine model of acute respiratory failure. / Reickert, Craig A.; Rich, Preston B.; Crotti, Stefania; Mahler, Simon A.; Awad, Samir S.; Lynch, William R.; Johnson, Kent J.; Hirschl, Ronald B.

In: Critical Care Medicine, Vol. 30, No. 1, 2002, p. 182-189.

Research output: Contribution to journalArticle

Reickert, CA, Rich, PB, Crotti, S, Mahler, SA, Awad, SS, Lynch, WR, Johnson, KJ & Hirschl, RB 2002, 'Partial liquid ventilation and positive end-expiratory pressure reduce ventilator-induced lung injury in an ovine model of acute respiratory failure', Critical Care Medicine, vol. 30, no. 1, pp. 182-189.
Reickert, Craig A. ; Rich, Preston B. ; Crotti, Stefania ; Mahler, Simon A. ; Awad, Samir S. ; Lynch, William R. ; Johnson, Kent J. ; Hirschl, Ronald B. / Partial liquid ventilation and positive end-expiratory pressure reduce ventilator-induced lung injury in an ovine model of acute respiratory failure. In: Critical Care Medicine. 2002 ; Vol. 30, No. 1. pp. 182-189.
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AU - Reickert, Craig A.

AU - Rich, Preston B.

AU - Crotti, Stefania

AU - Mahler, Simon A.

AU - Awad, Samir S.

AU - Lynch, William R.

AU - Johnson, Kent J.

AU - Hirschl, Ronald B.

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N2 - Objective: To examine the isolated and combined effects of positive end-expiratory pressure (PEEP) and partial liquid ventilation (PLV) on the development of ventilator-induced lung injury in an ovine model. Design: Prospective controlled animal study. Setting: University-based cardiovascular animal physiology laboratory. Subjects: Thirty-eight anesthetized supine sheep weighing 22.3 ± 2.2 kg. Interventions: Animals were ventilated for 6 hrs (respiratory rate, 15; F102, 1.0, inspiratory/expiratory ratio, 1:1) with one of five pressure-controlled strategies, expressed as peak inspiratory pressure (PIP)/PEEP: low-PIP, 25/5 cm H2O (n = 8); high-PIP, 50/5 cm H2O (n = 8); high-PIP-PLV, 50/5 cm H2O-PLV (n = 8); high-PEEP, 50/20 cm H2O (n = 7); and high-PEEP-PLV, 50/20 cm H2O-PLV (n = 7). Measurements and Main Results: Compared with the low-PIP control, high-PIP ventilation increased airleak, shunt, histologic evidence of lung injury, neutrophil infiltrates, and wet lung weight. Maintaining PEEP at 20 cm H2O or adding PLV reduced the development of physiologic shunt and dependent histologic injury indexes. Neither higher PEEP nor PLV reduced the high incidence of barotrauma observed in high-PIP animals. Conclusions: We conclude that application of PLV or PEEP at 20 cm H2O may improve gas exchange and afford lung protection from ventilator-induced lung injury during high-pressure mechanical ventilation in this model.

AB - Objective: To examine the isolated and combined effects of positive end-expiratory pressure (PEEP) and partial liquid ventilation (PLV) on the development of ventilator-induced lung injury in an ovine model. Design: Prospective controlled animal study. Setting: University-based cardiovascular animal physiology laboratory. Subjects: Thirty-eight anesthetized supine sheep weighing 22.3 ± 2.2 kg. Interventions: Animals were ventilated for 6 hrs (respiratory rate, 15; F102, 1.0, inspiratory/expiratory ratio, 1:1) with one of five pressure-controlled strategies, expressed as peak inspiratory pressure (PIP)/PEEP: low-PIP, 25/5 cm H2O (n = 8); high-PIP, 50/5 cm H2O (n = 8); high-PIP-PLV, 50/5 cm H2O-PLV (n = 8); high-PEEP, 50/20 cm H2O (n = 7); and high-PEEP-PLV, 50/20 cm H2O-PLV (n = 7). Measurements and Main Results: Compared with the low-PIP control, high-PIP ventilation increased airleak, shunt, histologic evidence of lung injury, neutrophil infiltrates, and wet lung weight. Maintaining PEEP at 20 cm H2O or adding PLV reduced the development of physiologic shunt and dependent histologic injury indexes. Neither higher PEEP nor PLV reduced the high incidence of barotrauma observed in high-PIP animals. Conclusions: We conclude that application of PLV or PEEP at 20 cm H2O may improve gas exchange and afford lung protection from ventilator-induced lung injury during high-pressure mechanical ventilation in this model.

KW - Barotrauma

KW - Fluorocarbons

KW - Mechanical ventilators

KW - Partial liquid ventilation

KW - Respiratory insufficiency

KW - Ventilator-induced lung injury

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