Partielle Flüssigkeitsbeatmung im Vergleich zur konventionellen Beatmung und zur Hochfrequenzoszillation mit Surfactanttherapie : Auswirkungen auf Gasaustausch und Lungenpathologie im Neugeborenen-Tiermodell

摘要

Partial liquid ventilation (PLV) showed to improve gas exchange in neonatal respiratory distress syndrome and to reduce ventilator associated lung injury. The aim of this study was to compare the effects of partial liquid ventilation combined with conventional ventilation (PLV/CV), CV combined with surfactant (S + CV) and High frequency oscillatory ventilation combined with surfactant (S + HFOV). We also investigated if there is any synergistic effect on gas exchange and lung protection with the combination of PLV and HFOV (PLV/HFOV). 32 newborn piglets were randomized in four groups. Lung injury was induced by repeated saline lung lavage. After thirty minutes we started the specific ventilatory treatment, which was continued for a 24h study period. All groups showed an improvement of oxygenation index (OI) and PaO2/FiO2 ratio within the first 60 minutes after starting treatment. After 18 and 24 hours OI was significantly better in the PLV/CV group compared with the S + CV group. No differences in gas exchange were noted between the PLV/CV and the S + HFOV group. The combination of PLV with HFOV led to an increased PaO2/FiO2 ratio when compared with the PLV/CV group. On histologic investigation all PLV treated animals showed significantly less lung injury in the upper and lower lobes compared with gas-ventilated animals. On morphometric analysis we observed less lung injury in the lower lobes of both PLV groups. In conclusion, PLV either alone or in combination with HFOV are effective techniques to provide adequate gas exchange in neonatal respiratory distress syndrome. Furthermore ventilator induced lung injury was significantly improved in both PLV treated groups compared with gas-ventilated animals.