Mrozek J D, Bing D R, Meyers P A, Connett J E, Mammel M C
Infant Pulmonary Research Center, Children's Health Care, St. Paul, Minnesota, USA.
Pediatr Pulmonol. 1998 Jul;26(1):21-9. doi: 10.1002/(sici)1099-0496(199807)26:1<21::aid-ppul5>3.0.co;2-l.
Surfactant followed by partial liquid ventilation (PLV) with perfluorocarbon (PFC; LiquiVent) improves oxygenation, lung compliance, and lung pathology in lung-injured animals receiving conventional ventilation (CV). In this study, we hypothesize that high-frequency oscillation (HFO) and CV will provide equivalent oxygenation in lung-injured animals following surfactant repletion and PLV, once lung volume is optimized. After saline-lavage lung injury during CV, newborn piglets were randomized to either HFO (n = 10) or CV (n = 9). HFO animals were stabilized over 15 min without optimization of lung volume; CV animals continued treatment with time-cycled, pressure-limited, volume-targeted ventilation. All animals then received 100 mg/kg of surfactant (Survanta). Thirty minutes later, all received intratracheal PFC to approximate functional residual capacity. Thirty minutes after PLV began, mean airway pressure (MAP) in both groups was increased to improve oxygenation. MAP was directly adjusted during HFO; PEEP and PIP were adjusted during IMV, maintaining a pressure sufficient to deliver 15 mL/kg tidal volume. Animals were treated for 4 h. The CV group showed improved oxygenation following surfactant administration (OI: 26.79 +/- 1.98 vs. 8.59 +/- 6.29, P < 0.0004), with little further improvement following PFC administration or adjustments in MAP. Oxygenation in HFO-treated animals did not improve following surfactant, but did improve following PFC (0I: 27.78 +/- 6.84 vs. 15.86 +/- 5.53, P < 0.005) and adjustments in MAP (OI: 15.86 +/- 5.53 vs. 8.96 +/- 2.18, P < 0.03). After MAP adjustments, there were no significant intergroup differences in oxygenation. Animals in the CV group required lower MAP than animals in the HFO group to maintain similar oxygenation. We conclude that surfactant repletion followed by PLV improves oxygenation during both CV and HFO. The initial response to administration of surfactant and PFC was different for the conventional and high-frequency oscillation groups, likely reflecting the ventilation strategy used; animals in the CV group responded most to surfactant, whereas animals in the HFO group responded most after PFC instillation. The ultimately similar oxygenation of the two groups once lung volume had been optimized suggests that HFO may be used effectively during administration of, and treatment with, surfactant and perfluorocarbon.
在接受传统通气（CV）的肺损伤动物中，先给予表面活性剂，然后进行全氟碳化合物（PFC；LiquiVent）部分液体通气（PLV），可改善氧合、肺顺应性和肺病理状况。在本研究中，我们假设在肺损伤动物补充表面活性剂和进行PLV后，一旦肺容积得到优化，高频振荡（HFO）和CV将提供同等的氧合效果。在CV期间进行盐水灌洗致肺损伤后，新生仔猪被随机分为HFO组（n = 10）或CV组（n = 9）。HFO组动物在未优化肺容积的情况下稳定15分钟；CV组动物继续采用时间切换、压力限制、容量目标通气进行治疗。然后所有动物均接受100mg/kg的表面活性剂（Survanta）。30分钟后，所有动物均经气管内给予PFC以接近功能残气量。PLV开始30分钟后，两组的平均气道压（MAP）均升高以改善氧合。在HFO期间直接调整MAP；在间歇指令通气（IMV）期间调整呼气末正压（PEEP）和吸气峰压（PIP），维持足以输送15mL/kg潮气量的压力。动物治疗4小时。CV组在给予表面活性剂后氧合改善（氧合指数：26.79±1.98 vs. 8.59±6.29，P < 0.0004），在给予PFC或调整MAP后进一步改善甚微。HFO治疗的动物在给予表面活性剂后氧合未改善，但在给予PFC后改善（氧合指数：27.78±6.84 vs. 15.86±5.53，P < 0.005），在调整MAP后也改善（氧合指数：15.86±5.53 vs. 8.96±2.18，P < 0.03）。MAP调整后，两组在氧合方面无显著组间差异。CV组动物维持相似氧合所需的MAP低于HFO组动物。我们得出结论，补充表面活性剂后进行PLV可改善CV和HFO期间的氧合。传统通气组和高频振荡组对表面活性剂和PFC给药的初始反应不同，这可能反映了所采用的通气策略；CV组动物对表面活性剂反应最大，而HFO组动物在滴注PFC后反应最大。一旦肺容积得到优化，两组最终相似的氧合表明HFO在表面活性剂和全氟碳化合物的给药及治疗过程中可能有效使用。
