Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
Physiol Meas. 2010 Aug;31(8):S85-95. doi: 10.1088/0967-3334/31/8/S07. Epub 2010 Jul 21.
Regional lung overdistension occurring during high frequency oscillatory ventilation (HFOV) and partial liquid ventilation (PLV) was investigated in a prospective animal trial using 18 mechanically ventilated Yorkshire swine under general anesthesia. Lung injury was induced with saline lavage and augmented using large tidal volumes. Electrical impedance tomography (EIT) and regional lung histopathology were used to identify regional lung overdistension during HFOV. Lung injury was quantified using a histopathologic lung injury score. The animals were randomized to three groups (n = 6 animals in each group): a control group and two dose groups of perfluorooctyl bromide (PFOB) (PFOB-Lo 1.5 ml kg(-1) and PFOB-Hi 3 ml kg(-1)). The animals were transitioned from conventional ventilation to HFOV, and a slow inflation-deflation maneuver was performed by changing mean airway pressure (Paw) by 5 cmH(2)O every 15 min to a maximum Paw of 40 cmH(2)O. In dependent lung areas, the PFOB-Hi (3 ml kg(-1)) group, in comparison with the control group, was associated with significantly greater alveolar overdistension seen on lung histopathology (P < 0.001 compared to control), a decreased mean impedance (P < 0.05 compared to the control group) and a decreased ventilation-induced impedance change during HFOV (P < 0.05 compared to the control group). We conclude that treatment with PFOB-Hi during HFOV compared to a control group in an animal model of lung injury led to regional overdistension of dependent lung areas, as evidenced by increased alveolar overdistension on lung histopathology, decreased mean lung impedance and decreased HFOV-induced regional lung volume changes as measured by EIT.
在全身麻醉下，使用 18 头机械通气的约克夏猪进行前瞻性动物试验，研究高频振荡通气（HFOV）和部分液体通气（PLV）期间区域性肺过度膨胀的情况。通过盐水灌洗诱导肺损伤，并通过大潮气量增加肺损伤。使用电阻抗断层成像（EIT）和区域性肺组织病理学来识别 HFOV 期间的区域性肺过度膨胀。使用组织病理学肺损伤评分来量化肺损伤。将动物随机分为三组（每组 6 只动物）：对照组和两种全氟辛基溴（PFOB）剂量组（PFOB-Lo 1.5 ml/kg 和 PFOB-Hi 3 ml/kg）。将动物从常规通气过渡到 HFOV，并通过每 15 分钟改变平均气道压力（Paw）5 cmH2O 来进行缓慢的膨胀-瘪陷操作，最大 Paw 为 40 cmH2O。在依赖区，与对照组相比，PFOB-Hi（3 ml/kg）组在肺组织病理学上显示出明显更大的肺泡过度膨胀（与对照组相比，P <0.001），平均阻抗降低（与对照组相比，P <0.05）和 HFOV 期间通气诱导的阻抗变化减少（与对照组相比，P <0.05）。我们得出结论，与肺损伤动物模型中的对照组相比，HFOV 期间使用 PFOB-Hi 治疗导致依赖区的区域性过度膨胀，这表现在肺组织病理学上的肺泡过度膨胀增加、平均肺阻抗降低和 EIT 测量的 HFOV 诱导的区域性肺容积变化减少。
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