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Selective tracheal gas insufflation during partial liquid ventilation improves lung function in an animal model of unilateral acute lung injury

Blanch, Lluis MD, PhD; Van der Kloot, Thomas E. MD; Youngblood, A. Melynne MD; Adams, Alex B. RRT; Naveira, Alberto MD; Murias, Gaston MD; Romero, Pablo V. MD, PhD; Nahum, Avi MD, PhD

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Objective  During unilateral lung injury, we hypothesized that we can improve global lung function by applying selective tracheal gas insufflation (TGI) and partial liquid ventilation (PLV) to the injured lung.

Design  Prospective, interventional animal study.

Setting  Animal laboratory in a university hospital.

Subjects  Adult mixed-breed dogs.

Interventions  In six anesthetized dogs, left saline lung lavage was performed until Pao2/Fio2 fell below 100 torr (13.3 kPa). The dogs were then reintubated with a Univent single-lumen endotracheal tube, which incorporates an internal catheter to provide TGI. In a consecutive manner, we studied 1) the application of 10 cm H2O of positive end-expiratory pressure (PEEP); 2) instillation of 10 mL/kg of perflubron (Liquivent) to the left lung at a PEEP level of 10 cm H2O (PLV+PEEP 10 initial); 3) application of selective TGI (PLV+TGI) while maintaining end-expiratory lung volume (EELV) constant; 4) PLV+TGI at reduced tidal volume (<˙;V>t); and 5) PLV+PEEP 10 final.

Measurements and Main Results  Application of PLV+PEEP 10 initial did not change gas exchange, lung mechanics, or hemodynamics. PLV+TGI improved Pao2/Fio2 from 189 ± 13 torr (25.2 ± 1.7 kPa) to 383 ± 44 torr (51.1 ± 5.9 kPa) (p < .01) and decreased Paco2 from 55 ± 5 torr (7.3 ± 0.7 kPa) to 30 ± 2 torr (4.0 ± 0.3 kPa) (p < .01). During ventilation with PLV+TGI, reducing <˙;V>t from 15 mL/kg to 3.5 mL/kg while keeping EELV constant decreased Pao2/Fio2 to 288 ± 49 torr (38.4 ± 6.5 kPa) (not significant) and normalized Paco2. At this stage, end-inspiratory plateau pressure decreased from 19.2 ± 0.7 cm H2O to 13.6 ± 0.7 cm H2O (p < .01). At PLV+PEEP 10 final, measurements returned to those observed at previous baseline stage (PLV+PEEP 10 initial).

Conclusions  During unilateral lung injury, PLV with a moderate PEEP did not improve oxygenation, TGI superimposed on PLV improved gas exchange, and combination of TGI and PLV allowed a 77% reduction in <˙;V>t without any adverse effect on Paco2.

From the Department of Pulmonary and Critical Care Medicine, University of Minnesota, Regions Hospital, St. Paul, MN (TV, MY, ABA, AN, GA, AN); the Servei de Medicina Intensiva, Hospital de Sabadell, Corporació Parc Tauli, Sabadell, Spain (LB); and the Servei de Pneumologia i Unitat de Recerca Experimental, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain (PVR).

Supported by Regions Foundation and National Institutes of Health SCOR HL-50152. Lluis Blanch was supported by grant BAE 97/5478 from FIS (Spain).

The use of selective tracheal gas insufflation and partial liquid ventilation at low tidal volume is a simple method to provide regional recruitment, enhancing gas exchange while reducing cyclic lung stretch and shear stresses associated with mechanical ventilation.

© 2001 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins