The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

PARTIAL LIQUID VENTILATION WITH AND WITHOUT SURFACTANT IN AN IRDS MODEL.

Dennis Bing RRT, Jeanne Mrozek MD, Kendra Smith MD, Patricia Meyers RRT, RayeAnn deRegnier MD, John Connett PhD, Mark Mammel MD. Children's Health Care - St. Paul, and Depts of Pediatrics of Biostatistics, University of Minnesota, Minneapolis, MN.

Surfactant replacement is now a standard treatment for IRDS; partial liquid ventilation (PLV) is just on the horizon. Both improve oxygenation and lung compliance. Are benefits additive when the two surface-active agents are intermixed? Does order of administration matter? We evaluated the effects of PLV using a perfluorocarbon (Liqui Vent(r)) and surfactant (Survanta(r)) alone and given together in 32 newborn piglets (1.51±0.38 kg) with saline lavage-induced lung injury (PaO2 < 60 torr, FiO2 1.0). We randomized animals into four groups of 8 each: surfactant only (S), surfactant followed by PLV (S-PLV), PLV only, and PLV followed by surfactant (PLV-S). S and S-PLV animals received surfactant after induction of lung injury. PLV began 30 minutes after surfactant. PLV and PLV-S animals had perfluorocarbon instilled intratracheally (30-50 mL/kg) after lung injury. PLV-S animals received surfactant 30 minutes after starting PLV. Using a conventional neonatal ventilator (Drager Babylog(r)), we adjusted PIP to maintain tidal volume at 15 cc/kg and FiO2 in an attempt to keep PaO2 100- 150 torr. We measured arterial blood gases, arterial and central venous pressures, heart rates, and dynamic and static respiratory system mechanics and calculated A/a ratio and OI every 30 minutes for two hours following final treatment. We analyzed absolute values and % \delta from baseline after lung injury using ANOVA, then Newman-Keuls post-hoc tests.

at 60 minutes at 120 minutes

%\delta Cdyn %\delta OI %\delta Cdyn %\delta OI

S 13.8^{*} 62.0 13.3^{*} 47.5^{*}

S-PLV 64.5 73.7 72.6 77.1

PLV 40.2 74.2 45.1 75.5

PLV-S 36.5 79.6 44.5 82.8

^{*} p < 0.05, S vs other groups.

Physiologic parameters were not different. S-PLV produced the largest % \delta Cdyn throughout the study period. S alone showed less improvement in Cdyn and OI compared to S-PLV, PLV, or PLV-S. Conclusions: In this model of neonatal RDS, improvement in oxygenation and compliance was better in all groups employing PLV than surfactant alone. Benefits of combining surfactant with PLV in either order were not consistent. (Liqui Vent(r) supplied by Alliance Pharmaceutical Corp; Survanta(r) supplied by Ross Laboratories, Inc)

Reference: OF-96-129

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