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  • Title: Development and application of a double-piston configured, total-liquid ventilatory support device.
    Author: Meinhardt JP, Quintel M, Hirschl RB.
    Journal: Crit Care Med; 2000 May; 28(5):1483-8. PubMed ID: 10834700.
    Abstract:
    OBJECTIVE: Perfluorocarbon liquid ventilation has been shown to enhance pulmonary mechanics and gas exchange in the setting of respiratory failure. To optimize the total liquid ventilation process, we developed a volume-limited, time-cycled liquid ventilatory support, consisting of an electrically actuated, microprocessor-controlled, double-cylinder, piston pump with two separate limbs for active inspiration and expiration. DESIGN: Prospective, controlled, animal laboratory study, involving sequential application of conventional gas ventilation, partial ventilation (PLV), and total liquid ventilation (TLV). SETTING: Research facility at a university medical center. SUBJECTS: A total of 12 normal adult New Zealand rabbits weighing 3.25+/-0.1 kg. INTERVENTIONS: Anesthestized rabbits were supported with gas ventilation for 30 mins (respiratory rate, 20 cycles/min; peak inspiratory pressure, 15 cm H2O; end-expiratory pressure, 5 cm H2O), then PLV was established with perflubron (12 mL/kg). After 15 mins, TLV was instituted (tidal volume, 18 mL/kg; respiratory rate, 7 cycles/min; inspiratory/expiratory ratio, 1:2 cycles/min). After 4 hrs of TLV, PLV was re-established. MEASUREMENTS AND MAIN RESULTS: Of 12 animals, nine survived the 4-hr TLV period. During TLV, mean values +/- SEM were as follows: PaO2, 363+/-30 torr; PaCO2, 39+/-1.5 torr; pH, 7.39+/-0.01; static peak inspiratory pressure, 13.2+/-0.2 cm H2O; static endexpiratory pressure, 5.5+/-0.1 cm H2O. No significant changes were observed. When compared with gas ventilation and PLV, significant increases occurred in mean arterial pressure (62.4+/-3.5 torr vs. 74.0+/-1.2 torr) and central venous pressure (5.6+/-0.7 cm H2O vs. 7.8+/-0.2 cm H2O) (p < .05). CONCLUSIONS: Total liquid ventilation can be performed successfully utilizing piston pumps with active expiration. Considering the enhanced flow profiles, this device configuration provides advantages over others.
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