From the Inserm, U955, Equipe 3, Créteil, France (R.T., F.L., L.D., M.K., S.P., M.C., B.G., and A.B.); Université Paris-Est, UMR_S955, UPEC, Créteil, France (R.T., F.L., L.D., M.K., S.P., M.C., B.G., and A.B.); Université Paris Est, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France (R.T., F.L., L.D., M.K., S.P., M.C., B.G., and A.B.); CHU de Poitiers, Service de Biochimie, Poitiers, France (S.G. and T.H.); Inserm U1082, Poitiers, France (S.G., N.Q., J.-M.G., and T.H.); Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France (S.G., B.F., J.-M.G., and T.H.); CHU de Poitiers, Service d'Anatomie pathologique, Poitiers, France (N.Q., B.F., J.-M.G.); INSERM U970, Paris, France (P.B.).
Anesthesiology. 2014 Apr;120(4):861-9. doi: 10.1097/ALN.0000000000000048.
Total liquid ventilation (TLV) with perfluorocarbons has been shown to induce rapid protective cooling in animal models of myocardial ischemia and cardiac arrest, with improved neurological and cardiovascular outcomes after resuscitation. In this study, the authors hypothesized that hypothermic TLV can also limit kidney injury after cardiac arrest.
Anesthetized rabbits were submitted to 15 min of untreated ventricular fibrillation. After resuscitation, three groups of eight rabbits each were studied such as (1) life support plus hypothermia (32°-33 °C) induced by cold TLV (TLV group), (2) life support without hypothermia (control group), and (3) Sham group (no cardiac arrest). Life support was continued for 6 h before euthanasia and kidney removal.
Time to target esophageal temperature was less than 5 min in the TLV group. Hypothermia was accompanied by preserved renal function in the TLV group as compared with control group regarding numerous markers including creatinine blood levels (12 ± 1 vs. 16 ± 2 mg/l, respectively; mean ± SEM), urinary N-acetyl-β-(D)-glucosaminidase (1.70 ± 0.11 vs. 3.07 ± 0.10 U/mol of creatinine), γ-glutamyltransferase (8.36 ± 0.29 vs. 12.96 ± 0.44 U/mol of creatinine), or β2-microglobulin (0.44 ± 0.01 vs. 1.12 ± 0.04 U/mol of creatinine). Kidney lesions evaluated by electron microscopy and conventional histology were also attenuated in TLV versus control groups. The renal-protective effect of TLV was not related to differences in delayed inflammatory or immune renal responses because transcriptions of, for example, interferon-γ, tumor necrosis factor-α, interleukin-1β, monocyte chemoattractant protein-1, toll-like receptor-2, toll-like receptor-4, and vascular endothelial growth factor were similarly altered in TLV and control versus Sham.
Ultrafast cooling with TLV is renal protective after cardiac arrest and resuscitation, which could increase kidney availability for organ donation.
全氟化碳液体通气（TLV）已被证明可在心肌缺血和心脏骤停的动物模型中迅速诱导保护性冷却，从而改善复苏后的神经和心血管结局。在这项研究中，作者假设低温 TLV 还可以限制心脏骤停后的肾脏损伤。
麻醉兔经历 15 分钟未经治疗的心室颤动。复苏后，每组 8 只兔子分别研究以下三组：（1）低温 TLV 诱导的生命支持加低温（32°-33°C）（TLV 组），（2）无低温的生命支持（对照组），以及（3）假手术组（无心脏骤停）。在安乐死和肾脏切除前，继续生命支持 6 小时。
TLV 组达到目标食管温度的时间不到 5 分钟。与对照组相比，TLV 组低温时的肾功能得到了保留，多个标志物均如此，包括血肌酐水平（分别为 12±1 和 16±2mg/L，平均值±SEM）、尿 N-乙酰-β-（D）-氨基葡萄糖苷酶（1.70±0.11 和 3.07±0.10U/mol 肌酐）、γ-谷氨酰转移酶（8.36±0.29 和 12.96±0.44U/mol 肌酐）或β2-微球蛋白（0.44±0.01 和 1.12±0.04U/mol 肌酐）。电镜和常规组织学评估的肾脏病变也在 TLV 组与对照组之间减轻。TLV 的肾脏保护作用与延迟的炎症或免疫性肾反应的差异无关，因为例如干扰素-γ、肿瘤坏死因子-α、白细胞介素-1β、单核细胞趋化蛋白-1、Toll 样受体-2、Toll 样受体-4 和血管内皮生长因子的转录在 TLV 和对照组与假手术组之间也有类似的改变。
心脏骤停和复苏后，TLV 的超快冷却具有肾脏保护作用，这可以增加肾脏用于器官捐献的可用性。
