Experimental Research of Partial Liquid Ventilation with Perfluorocarbon on Acute Lung Injury Induced by Cardiopulmonary Bypass_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIE Yewei , ZHENG Jinghao , XU Zhiwei

epartment of Pediatric and Cardiothoracic Surgery, Shanghai Children’s Medical Center, Xinhua Hospital, Medical College, Shanghai Jiaotong University, Shanghai 200127, P.R.China. E-mail: xieyw88288@163.com;

Corresponding author：

Keywords：

Perfluorocarbon; Partial liquid ventilation; Acute lung injury; Continuous pulmonary perfusion; Cardiopulmonary bypass

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Objective To investigate the effect of partial liquid ventilation (PLV) with perfluorocarbon(PFC) and continuous pulmonary artery perfusion (CPP) on lung gas exchange and lung inflammatory reaction in acute lung injury(ALI) induced by cardiopulmonary bypass (CPB). Methods Eighteen of either sex piglets(weighting10.2±1.6kg) were randomly divided into three groups: Control group, CPP+CPB group (CPP group), PLV+CPP+CPB group (PLV group). Animals in control group received no treatment but conventional mechanical ventilation.In CPP group lung perfusion with oxygenated blood at 20-25ml/kg·min was given during aortic clamping. In PLV group PFC (FDC)12ml/kg was instilled into the trachea right after CPB stopping. The changes of gas exchange were mearsured before CPB and at 0h, 1h, 2h, 3h after CPB stopping. Histological sections were taken from right and left downsides of lung. Results Compared with control group, the partial pressure of oxygen in artery (PaO2) significantly increased and alveolar-aterial oxygen gradient(AaDO2) markedly decreased after 1h in PLV group(P lt;005) and partial pressure of carbon dioxide in artery (PaCO2) also became small after 3h (P lt;005).The change of gas exchange in CPP group was markedly improved. And role of lung protection of PLV was more better than that of CPP. Light microscopy: Express of intercellular adhesion molecule-1(ICAM-1) in the histopathological lesions of lung was bely positive in control group than that of PLV group and CPP group. Conclusion PLV and continuous pulmonary artery perfusion can improve the oxygenation of lung and inhibit inflammatory reaction of acute lung injury induced by CPB

Citation： XIE Yewei,ZHENG Jinghao,XU Zhiwei,JIANG Zuming,YU Xiaoqing,ZOU Wenyan. Experimental Research of Partial Liquid Ventilation with Perfluorocarbon on Acute Lung Injury Induced by Cardiopulmonary Bypass. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2007, 14(6): 438-. doi: Copy

1.	Ng CS, Wan S, Yim AP,et al. Pulmonary dysfunction after cardiac surgery.Chest, 2002,121(4):1269-1277.
2.	Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg, 2002,21(2):232-244.
3.	Pintar T,Collard CD.The systemic inflammatory response to cardiopulmonary bypass. Anesthesiol Clin North America,2003, 21(3):453-464.
4.	Zobel G, Rdl S, Urlesberger B, et al. Partial liquid ventilation combined with two different gas ventilatory strategies in acute lung injury in piglets: Effects on gas exchange, respiratory mechanics, and hemodynamics. J Pediatr Surg, 2003, 38(4):527-533.
5.	Cheifetz IM,Cannon ML,Craig DM, et al. Liquid ventilation improves pulmonary function and cardiac output in a neonatal swine model of cardiopulmonary bypass. J Thorac Cardiovascular Surg,1998,115(3):528-535.
6.	Davies MW, Sargent PH. Partial liquid ventilation for the prevention of mortality and morbidity in paediatric acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev, 2004,2:CD003845.
7.	Nugent LJ, Mazzoni MC, Flaim SF, et al.Dose maintenance for partial liquid ventilation: passive heat-and-moisture exchanges. Biomed Instrum Technol, 1999, 33 (4) :365-372.
8.	Nakamura T, Tamura M.Partial liquid ventilation with low dose of perflubron and a low stretch ventilation strategy improves oxygenation in a rabbit model of surfactant depletion. Biol Neonate, 2002, 82(1):66-69.
9.	Thome UH,Schulze A,Schnabel R, et al. Partial liquid ventilation in severely surfactant-depleted,spontaneously breathing rabbits supported by proportional assist ventilation. Crit Care Med, 2001,29(6):1175-1180.
10.	Huang H, Yao T, Wang W, et al.Combination of balanced ultrafiltration with modified ultrafiltration attenuates pulmonary injury in patients undergoing open heart surgery. Chin Med J (Engl), 2003, 116(10):1504-1507.
11.	Abraham E.Neutrophils and acute lung injury.Crit Care Med, 2003,31(4 Suppl):S195-S199.
12.	Jensen E, Bengtsson A,Berggren H, et al.Clinical variables and pro-inflammatory activation in paediatric heart surgery. Scand Cardiovasc J, 2001,35(3):201-206.
13.	Asimakopoulos G, Smith PL, Ratnatunga CP,et al. Lung injury andacute respiratory distress syndrome after cardiopulmonary bypass. Ann Thorac Surg,1999,68 (3) :1107-1115.
14.	Haeberle HA, Nesti F, Diet rich HJ, et al.Perflubron reduces lung inflammation in respiratory syncytial virus infection by inhibiting chemokine expression and nuclear factor-kappa B activation.Am J Respir Crit Care Med, 2002,165(10):1433-1438.
15.	Koch T, Ragaller M, Haufe D, et al. Perfluorohexane attenuates proinflammatory and procoagulatory response of activated monocytes and alveolar macrophages. Anesthesiology,2001, 94(1):101-109.
16.	Schroeder S, Brger N, Wrigge H, et al. A tumor necrosis factor gene polymorphism influences the inflammatory response after cardiac operation. Ann Thorac Surg, 2003,75(2):534-537.
17.	Decleva E, Dri P, Menegazzi R, et al. Evidence that TNF-induced respiratory burst of adherent PMN is mediated by integrin alpha(L) beta (2).J Leukoc Biol, 2002,72(4):718-726.
18.	Maianski NA, Roos D, Kuijpers TW. Tumor necrosis factor alpha induces a caspase independent death pathway in human neutrophils. Blood, 2003, 101(5):1987-1995.
19.	Hill GE, Whitten CW, Landers DF. The influence of cardiopulmonary bypass on cytokines and cell-cell commu-nication. J Cardiothorac Vasc Anesth, 1997,11(3):367-375.
20.	Zheng JH, Xu ZW, Wang W, et al. Lung perfusion with oxygenated blood during aortic clamping prevents lung injury. Asian Cardiovasc Thorac Ann, 2004,12(1):58-60.
21.	Liu Y, Wang Q, Zhu X, et al. Pulmonary artery perfusion with protective solution reduces lung injury after cardiopulmonary bypass.Ann Thorac Surg, 2000, 69(5):1402-1407.
22.	von der Hardt K, Schoof E,Kandler MA,et al. Aerosolized perfluorocarbon suppresses early pulmonary inflasmmatory response in a surfactant-depleted piglet model.Pediatrc Res,2002,51(2):177-182.

1. 　Ng CS, Wan S, Yim AP,et al. Pulmonary dysfunction after cardiac surgery.Chest, 2002,121(4):1269-1277.
2. 　Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg, 2002,21(2):232-244.
3. 　Pintar T,Collard CD.The systemic inflammatory response to cardiopulmonary bypass. Anesthesiol Clin North America,2003, 21(3):453-464.
4. 　Zobel G, Rdl S, Urlesberger B, et al. Partial liquid ventilation combined with two different gas ventilatory strategies in acute lung injury in piglets: Effects on gas exchange, respiratory mechanics, and hemodynamics. J Pediatr Surg, 2003, 38(4):527-533.
5. 　Cheifetz IM,Cannon ML,Craig DM, et al. Liquid ventilation improves pulmonary function and cardiac output in a neonatal swine model of cardiopulmonary bypass. J Thorac Cardiovascular Surg,1998,115(3):528-535.
6. 　Davies MW, Sargent PH. Partial liquid ventilation for the prevention of mortality and morbidity in paediatric acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev, 2004,2:CD003845.
7. 　Nugent LJ, Mazzoni MC, Flaim SF, et al.Dose maintenance for partial liquid ventilation: passive heat-and-moisture exchanges. Biomed Instrum Technol, 1999, 33 (4) :365-372.
8. 　Nakamura T, Tamura M.Partial liquid ventilation with low dose of perflubron and a low stretch ventilation strategy improves oxygenation in a rabbit model of surfactant depletion. Biol Neonate, 2002, 82(1):66-69.
9. 　Thome UH,Schulze A,Schnabel R, et al. Partial liquid ventilation in severely surfactant-depleted,spontaneously breathing rabbits supported by proportional assist ventilation. Crit Care Med, 2001,29(6):1175-1180.
10. 　Huang H, Yao T, Wang W, et al.Combination of balanced ultrafiltration with modified ultrafiltration attenuates pulmonary injury in patients undergoing open heart surgery. Chin Med J (Engl), 2003, 116(10):1504-1507.
11. 　Abraham E.Neutrophils and acute lung injury.Crit Care Med, 2003,31(4 Suppl):S195-S199.
12. 　Jensen E, Bengtsson A,Berggren H, et al.Clinical variables and pro-inflammatory activation in paediatric heart surgery. Scand Cardiovasc J, 2001,35(3):201-206.
13. 　Asimakopoulos G, Smith PL, Ratnatunga CP,et al. Lung injury andacute respiratory distress syndrome after cardiopulmonary bypass. Ann Thorac Surg,1999,68 (3) :1107-1115.
14. 　Haeberle HA, Nesti F, Diet rich HJ, et al.Perflubron reduces lung inflammation in respiratory syncytial virus infection by inhibiting chemokine expression and nuclear factor-kappa B activation.Am J Respir Crit Care Med, 2002,165(10):1433-1438.
15. 　Koch T, Ragaller M, Haufe D, et al. Perfluorohexane attenuates proinflammatory and procoagulatory response of activated monocytes and alveolar macrophages. Anesthesiology,2001, 94(1):101-109.
16. 　Schroeder S, Brger N, Wrigge H, et al. A tumor necrosis factor gene polymorphism influences the inflammatory response after cardiac operation. Ann Thorac Surg, 2003,75(2):534-537.
17. 　Decleva E, Dri P, Menegazzi R, et al. Evidence that TNF-induced respiratory burst of adherent PMN is mediated by integrin alpha(L) beta (2).J Leukoc Biol, 2002,72(4):718-726.
18. 　Maianski NA, Roos D, Kuijpers TW. Tumor necrosis factor alpha induces a caspase independent death pathway in human neutrophils. Blood, 2003, 101(5):1987-1995.
19. 　Hill GE, Whitten CW, Landers DF. The influence of cardiopulmonary bypass on cytokines and cell-cell commu-nication. J Cardiothorac Vasc Anesth, 1997,11(3):367-375.
20. 　Zheng JH, Xu ZW, Wang W, et al. Lung perfusion with oxygenated blood during aortic clamping prevents lung injury. Asian Cardiovasc Thorac Ann, 2004,12(1):58-60.
21. 　Liu Y, Wang Q, Zhu X, et al. Pulmonary artery perfusion with protective solution reduces lung injury after cardiopulmonary bypass.Ann Thorac Surg, 2000, 69(5):1402-1407.
22. 　von der Hardt K, Schoof E,Kandler MA,et al. Aerosolized perfluorocarbon suppresses early pulmonary inflasmmatory response in a surfactant-depleted piglet model.Pediatrc Res,2002,51(2):177-182.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Experimental Research of Partial Liquid Ventilation with Perfluorocarbon on Acute Lung Injury Induced by Cardiopulmonary Bypass

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