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Special Feature: Oral Presentations

PFC & BACTERIAL INFECTIONS

Rüdiger, Mario

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Pulmonary infections can lead to severe respiratory insufficiency with the subsequent need for respiratory support. Liquid ventilation with perfluorocarbons (PFCs) could be one method to treat the severe respiratory insufficiency. PRCs have been shown to exhibit anti-inflammatory properties which, up until now, were considered beneficial for preventing ventilation induced injury. However, it is unknown whether suppressed pulmonary inflammation will be beneficial in patients with bacterial infections. It could be speculated that suppressed inflammation leads to overwhelming infection and severe sepsis. In vitroData: In industrial fermentation processes PFCs are used to promote growth of bacteria. Furthermore, bacterial growth can be enhanced by incubating cell cultures with PFCs (Lowe 1998). However, the conditions during these processes differ from a clinical situation; therefore, experimental and clinical data were obtained. Incubation of E.coli or group B streptococci neither altered the growth nor the survival of the bacteria (Rüdiger 2001). Interestingly, perfluooroocytlbromide (PFOB) seems to have a direct bactericidal effect on Pseudomonas aeruginosa (Jung 2003). It was speculated that PFOB kills the bacteria by disrupting its cellular membrane. Furthermore, the bactericidal effect of aminoglycosides against P.aeruginosa was much more pronounced if administered in combination with PFOB (Jung 2002). It is speculated that PFCs affect the cell wall of P.aeruginosa and thus enhance the effects of aminoglycosides. Incubation of isolated type II pneumocytes with PF5080 did prevent the Chlamydia pneumoniae induced inflammatory cascade (Wissel 2006). That effect can be explained by a direct effect on cellular metabolism and also by a reduced invasion of Cpn into alveolar type II cells. In vivoData: In liquid ventilated rats with streptococcal pneumonia, the survival was significantly longer when compared to control animals (Dickson 1998). Furthermore, the risk of nosocomial pneumonia is not increased during partial liquid ventilation (Sajan 1999). However, in an animal model of P.aeruginosa, bacterial clearance was impaired during PLV (Rezaiguia-Delclaux 2003). In an animal model of gram negative (E.coli) pneumonia, partial liquid ventilation was not associated with an improvement, but rather with a deterioration of ventilatory parameters and oxygenation (Franz 2002). In contrast, in newborn rabbits with congenital group B streptococcal pneumonia, partial liquid ventilation reduced the bacterial growth and also reduced histological signs of pulmonary inflammation (Rüdiger 2003). Clinical Data: According to the available data, the incidence of pneumonia in PLV-treated patients does not differ from conventionally ventilated patients. Animal and laboratory data suggest that perfluorocarbons do not increase the risk of severe bacterial sepsis, despite having anti-inflammatory properties. However, the hemodynamic effects of liquid ventilation could cause further significant deteriorations in patients with severe sepsis. Thus, more animal studies would be of interest to improve the chance for a successful clinical application of liquid ventilation.

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