1995 OPEN FORUM Abstracts
Quick-Fill Vs Slow-Fill With Partial Liquid Ventilation
CR Wise, BS, RRT; RB Hirschl, MD; T Pranikoff, MD; RJ Shreiner, MD; P Gauger, MD; RH Bartlett MD; CF Haas, MLS, RRT. Departments of Respiratory Care and Surgery, University of Michigan Medical Center, Ann Arbor MI
INTRODUCTION: Developing bedside methods to deliver new modalities is done by trial, error and ingenuity. Techniques used during preliminary animals studies are often found awkward or inadequate during patient trials. This study describes two methods of instilling perflourocarbon (PFC) Alliance Pharmaceutical Corp, San Diego CA) during partial liquid ventilation (PLV).
Methods: All patients were placed on time-cycled pressure-controlled ventilation (7200ae, Puritan Bennett, Carlsbad CA) using normal to inverse I:E ratios. All patients were placed on FiO2 of 1.0 during each fill. Instillation method one (Quick-fill) involved briefly removing patients (n=2) from the ventilator, inserting a glass funnel into the endotracheal tube (ETT) and instilling 5 mL of PFC while observing SpO_2 and tidal volume (V_T). Patients were then reconnected to the ventilator and monitored. With method two (Slow-fill) patients (n=3) remained on the ventilator. A bronchoscopy adapter was inserted between the ETT and the patient wye. The glass funnel was connected to a red rubber suction catheter which was inserted into the adapter. Hemostats clamped the catheter to regulate flow of liquid as 5 mL of PFC was instilled. V_T and SpO_2 were monitored.
Results: Quick-fill (QF) had an initial drop in V_T to 3% of baseline; Slow-fill (SF) to 81%. At 1-2 min post instillation 40% vs 90% and at 3-5 min 75% vs 106% for QF vs SF respectively. Recovery of V_T to 90% of baseline ranged from 4-22 min for QF and 0-3 min for SF. SpO2 dropped in relation to V_T. Effect of PFC filling on each patients' V_T shows:
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Conclusions: Slow instillation allows the PFC to go into the peripheral areas of the lung during PFC administration, without a severe reduction in V_T and SpO_2.