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Am. J. Respir. Crit. Care Med., Volume 158, Number 1, July 1998, 249-255

Computer Tomographic Assessment of Perfluorocarbon and Gas Distribution during Partial Liquid Ventilation for Acute Respiratory Failure

MICHAEL QUINTEL, RONALD B. HIRSCHL, HARRY ROTH, REINHARD LOOSE, and KLAUS van ACKERN

Department of Anesthesiology, Department of Radiology, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Germany; and Department of Surgery, University of Michigan, Ann Arbor, Michigan

The average in vivo chest computed tomographic (CT) attenuation number (air = -1,000, soft tissue = 0, perflubron = +2,300 Hounsfield units [HU]) of 10 ventrodorsal-oriented lung segments was calculated to assess the distribution of gas and perflubron in 14 oleic acid lung-injured adult sheep during partial liquid ventilation (PLV, n = 7) or gas ventilation (GV, n = 7). Partial liquid ventilation was associated with a significant decrease in shunt fraction (PLV = 40 ± 12%, GV = 76 ± 12%, p = 0.004). Computed tomographic attenuation data during expiration (HUexp) demonstrated minimal gas aeration in GV animals in the dependent (segments 6-10) lung zones (HUexp = -562 ± 108 for segments 1-5, HUexp = -165 ± 104 for segments 6-10, p = 0.015). During PLV, perflubron was predominantly distributed to the dependent lung regions (HUexp = 579 ± 338 for segments 1-5, HUexp = 790 ± 149 for segments 6-10, p = 0.04). The ratio of the inspiratory to expiratory HU (HUinsp/exp) was greater in dependent than nondependent regions (mean HUinsp/exp segments 1-5 = 0.56, segments 6-10 = 0.81, p = 0.01), indicating that during inspiration relatively more gas than perflubron was distributed to the nondependent lung regions. We conclude that during PLV in this lung injury model, (1) gas exchange is improved when compared with gas ventilation, (2) perflubron is distributed predominantly to the dependent regions of the lung, and (3) although gas is distributed throughout the lung with each inspiration, more gas than perflubron goes to the nondependent lung regions.




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