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Perflubron Distribution During Transition From Gas to Total Liquid Ventilation
Michaël Sage1, Symon Stowe2, Andy Adler2
1Departments of Pediatrics and Pharmacology/Physiology, Université de Sherbrooke, Sherbrooke, QC, Canada.
Frontiers in Physiology
|December 18, 2018
Summary
Total liquid ventilation (TLV) requires 10 minutes for transition, clearing air and recruiting lung regions. This method improves ventilation-perfusion coupling in neonatal respiratory distress, but requires careful monitoring due to transient lung volume increases.
Area of Science:
- Neonatal Physiology and Respiratory Medicine
- Liquid Ventilation and Perfluorocarbons
- Medical Imaging and Monitoring Technologies
Background:
- Total liquid ventilation (TLV) using perfluorocarbons shows promise for neonatal respiratory distress.
- Understanding the early transition phase of TLV, particularly residual air management in non-dependent lung regions, is crucial for safety.
- Neonatal respiratory distress necessitates innovative ventilation strategies to improve outcomes.
Purpose of the Study:
- To assess perflubron distribution during the transition to TLV in a neonatal lamb model.
- To evaluate the early physiological changes, including lung volume and ventilation-perfusion coupling, during TLV initiation.
- To investigate the role of electrical impedance tomography (EIT) and fluoroscopy in monitoring TLV transition.
Main Methods:
- Eight neonatal lambs with induced surfactant deficiency underwent TLV using perflubron.
- Electrical impedance tomography (EIT) and fluoroscopy were used to monitor perflubron distribution and lung mechanics.
- Histological analysis and lung perfusion assessments were performed to complement imaging data.
Main Results:
- Transition to TLV involved a transient increase in total lung volume due to dependent lung recruitment.
- Perflubron filled non-dependent lung regions over at least 10 minutes without overdistention.
- TLV improved tidal volume distribution and ventilation-perfusion coupling compared to gas ventilation.
Conclusions:
- The transition to TLV takes at least 10 minutes, involving air evacuation, lung recruitment, and rapid ventilation-perfusion coupling.
- Transient increases in total lung volume during TLV transition necessitate careful management and real-time monitoring.
- Electrical impedance tomography is a valuable tool for real-time monitoring of TLV transition in neonatal respiratory distress.
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