Partial liquid ventilation combined with inhaled nitric oxide in acute respiratory failure with pulmonary hypertension in piglets

This study was a prospective, randomized, controlled design to evaluate gas exchange, lung mechanics, and pulmonary hemodynamics during partial liquid ventilation (PLV) combined with inhaled nitric oxide (NO) in acute respiratory failure (ARF) with pulmonary hypertension (PH). ARF with PH was induced in 12 piglets weighing 9.7-13.7 kg by repeated lung lavages and the continuous infusion of the stable endoperoxane analog of thromboxane. Thereafter the animals were randomly assigned either for PLV or conventional mechanical ventilation (CMV) at a fractional concentration of inspired O2 (Fio2) of 1.0. Perfluorocarbon (PFC) liquid (30 mL kg-1) was instilled into the endotracheal tube over 5 min followed by 5 mL kg-1h-1. All animals were treated with different concentrations of NO (1-10-20 ppm) inhaled in random order. Continuous monitoring included ECG, right atrial (Pra), mean pulmonary artery (Ppa), pulmonary capillary (Ppc'), and mean arterial (Pa) pressures, arteria oxygen saturation, and mixed venous oxygen saturation measurements. During PLV Pao2/Fio2 increased significantly from 8.2 +/- 0.4 kPa to 34.8 +/- 5.1 kPa (p < 0.01), whereas Pao2/FiO2 remained constant at 9.5 +/- 0.4 kPa during CMV. The infusion of the endoperoxane analog resulted in a sudden decrease of Pao2/Fio2 from 34.8 +/- 5.1 kPa to 14.1 +/- 0.4 kPa (p < 0.01) in the PLV group and from 9.5 +/- 0.4 kPa to 6.9 +/- 0.2 kPa (p < 0.05) in the control group. Inhaled NO significantly improved oxygenation in both groups (Pao2/Fio2: 45.7 +/- 5.3 kPa during PLV and 25.9 +/- 4.7 kPa during CMV). During inhalation of NO mean Ppa decreased significantly from 7.8 +/- 0.26 kPa to 4.2 +/- 0.26 kPa (p < 0.01) in the PLV group and from 7.4 +/- 0.26 kPa to 5.1 +/- 0.13 kPa (p < 0.01) in the control group. As documented in the literature PLV significantly improves oxygenation and lung mechanics in severe ARF. In addition, when ARF is associated with severe PH, the combined treatment of PLV and inhaled NO improves pulmonary hemodynamics resulting in better oxygenation.