• R B Hirschl, R Tooley, A Parent, K Johnson, and R H Bartlett.
• Department of Surgery, University of Michigan, Ann Arbor, USA.
• Crit. Care Med. 1996 Jun 1; 24 (6): 1001-8.

ObjectiveTo investigate whether pulmonary compliance and gas exchange will be sustained during "total" perfluorocarbon liquid ventilation followed by "partial" perfluorocarbon liquid ventilation when compared with gas ventilation in the setting of the acute respiratory distress syndrome (ARDS).Study DesignA prospective, controlled, laboratory study.SettingA university research laboratory.SubjectsTen sheep, weighing 12.7 to 25.0 kg.InterventionsLung injury was induced in ten young sheep, utilizing a right atrial injection of 0.07 mL/kg of oleic acid followed by saline pulmonary lavage. Bijugular venovenous extracorporeal life support access, a pulmonary artery catheter, and a carotid artery catheter were placed. When the alveolar-arterial O2 gradient was >/= 600 torr and PaO2 Measurements And Main ResultsAn increase in physiologic shunt (gas ventilation = 69 +/- 11%, total/partial liquid ventilation = 71 +/- 3%) and a decrease in static total pulmonary compliance measured at 20 mL/kg inflation volume (gas ventilation = O.48 +/- 0.03 mL/cm H2O/kg, total/partial liquid ventilation = 0.50 +/- 0.17 mL/cm H2O/kg) were observed in both groups with induction of lung injury. Physiologic shunt was significantly reduced during total and partial liquid ventilation when compared with physiologic shunt observed in the gas ventilation animals (gas ventilation = 93 +/- 8%, total liquid ventilation = 45 +/- 11%, p<.001; gas ventilation = 95 +/- 3%, partial liquid ventilation = 61 +/- 12%, p<.001), while static compliance was significantly increased in the total, but not the partial liquid ventilated animals when compared with the gas ventilated group (gas ventilation = 0.43 +/- 0.03 mL/cm H2O/kg, total liquid ventilation = 1.13 +/- 18 mL/cm H2O/kg, p <.001; gas ventilation = 0.41 +/- 0.02 mL/cm H2O/kg, partial liquid ventilation = 0.47 +/- 0.08, p = .151). In addition, the extracorporeal life support flow rate required to maintain adequate oxygenation was significantly lower in the total/partial liquid ventilation group when compared with that of the gas ventilation group (gas ventilation = 89 +/- 7 mL/kg/min, total liquid ventilation = 22 +/- 10 mL/kg/min, p <.001; gas ventilation = 91 +/- 12 mL/kg/min, partial liquid ventilation = 41 +/- 11 mL/kg/min, p < .001). Lung biopsy light microscopy demonstrated a marked reduction in alveolar hemorrhage, lung fluid accumulation, and inflammatory infiltration in the total/partial liquid ventilation animals when compared with the gas ventilation animals.ConclusionsIn a model of severe ARDS, pulmonary gas exchange is improved during total followed by partial liquid ventilation. Pulmonary compliance is improved during total, but not during partial liquid ventilation. Total followed by partial liquid ventilation was associated with a reduction in alveolar hemorrhage, pulmonary edema, and lung inflammatory infiltration.

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