High-frequency oscillation versus conventional ventilation following surfactant administration and partial liquid ventilation

Jeanne D. Mrozek, Dennis R. Bing, Pat A. Meyers, John E Connett, Mark C. Mammel

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18 Scopus citations

Abstract

Surfactant followed by partial liquid ventilation (PLV) with perfluorocarbon (PFC; LiquiVent® improves oxygenation, lung compliance, and lung pathology in lung-injured animals receiving conventional ventilation (CV). In this study, we hypothesize that high-frequency oscillation (HFO) and CV will provide equivalent oxygenation in lung-injured animals following surfactant repletion and PLV, once lung volume is optimized. After saline- lavage lung injury during CV, newborn piglets were randomized to either HFO (n = 10) or CV (n = 9). HFO animals were stabilized over 15 min without optimization of lung volume; CV animals continued treatment with time- cycled, pressure-limited, volume-targeted ventilation. All animals then received 100 mg/kg of surfactant (Survanta®). Thirty minutes later, all received intratracheal PFC to approximate functional residual capacity. Thirty minutes after PLV began, mean airway pressure (MAP) in both groups was increased to improve oxygenation. MAP was directly adjusted during HFO; PEEP and PIP were adjusted during IMV, maintaining a pressure sufficient to deliver 15 mL/kg tidal volume. Animals were treated for 4 h. The CV group showed improved oxygenation following surfactant administration (O1:26.79 ± 1.98 vs. 8.59 ± 6.29, P < 0.0004), with little further improvement following PFC administration or adjustments in MAP. Oxygenation in HFO-treated animals did not improve following surfactant, but did improve following PFC (O1:27.78 ± 6.84 vs. 15.86 ± 5.53, P < 0.005) and adjustments in MAP (O1:15.86 ± 5.53 vs. 8.96 ± 2.18, P < 0.03). After MAP adjustments, there were no significant intergroup differences in oxygenation. Animals in the CV group required lower MAP than animals in the HFO group to maintain similar oxygenation. We conclude that surfactant repletion followed by PLV improves oxygenation during both CV and HFO. The initial response to administration of surfactant and PFC was different for the conventional and high-frequency oscillation groups, likely reflecting the ventilation strategy used; animals in the CV group responded most to surfactant, whereas animals in the HFO group responded most after PFC instillation. The ultimately similar oxygenation of the two groups once lung volume had been optimized suggests that HFO may be used effectively during administration of, and treatment with, surfactant and perfluorocarbon.

Original languageEnglish (US)
Pages (from-to)21-29
Number of pages9
JournalPediatric pulmonology
Volume26
Issue number1
DOIs
StatePublished - Jul 1 1998

Keywords

  • Animal disease models
  • Fluorocarbons
  • High frequency ventilation
  • Mechanical ventilation
  • Pulmonary surfactant
  • Respiratory distress syndrome

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