A new paradigm for lung-conservative total liquid ventilation

Autor: Kohlhauer, Matthias, Boissady, Emilie, Lidouren, Fanny, de Rochefort, Ludovic, Nadeau, Mathieu, Rambaud, Jérôme, Hutin, Alice, Dubuisson, Rose-Marie, Guillot, Geneviève, Pey, Pascaline, Bruneval, Patrick, Fortin-Pellerin, Etienne, Sage, Michael, Walti, Hervé, Cariou, Alain, Ricard, Jean-Damien, Berdeaux, Alain, Mongardon, Nicolas, Ghaleh, Bijan, Micheau, Philippe, Tissier, Renaud
Přispěvatelé: INSERM U955, équipe 3, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), Aix Marseille Université (AMU), Centre National de la Recherche Scientifique (CNRS), Service d'anesthésie-réanimation [CHU Trousseau], CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Imagerie par Résonance Magnétique Médicale et Multi-Modalités (IR4M), Université Paris-Sud - Paris 11 (UP11)-Hôpital Bicêtre-Centre National de la Recherche Scientifique (CNRS), Centre de recherche Pernod Ricard, Unité d'Imagerie Médicale, École nationale vétérinaire d'Alfort (ENVA), Immunopathologie humaine, Institut National de la Santé et de la Recherche Médicale (INSERM), Espaces, Nature et Culture (ENeC), Université Paris-Sorbonne (UP4)-Centre National de la Recherche Scientifique (CNRS), Ecologie et Evolution des Microorganismes (EEM), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Unité de Soins Intensifs [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département de génie mécanique [Sherbrooke] (UdeS), Université de Sherbrooke (UdeS), École nationale vétérinaire - Alfort (ENVA), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), ANR-17-CE17-0016,COOLIVENT,Hypothermie thérapeutique par ventilation liquide totale(2017)
Jazyk: angličtina
Rok vydání: 2019
Předmět:
PFC
perfluorocarbon
Research paper
CT
computerized tomography
Liquid Ventilation
PLV
partial liquid ventilation
Critical Care
Swine
Biopsy
[SDV]Life Sciences [q-bio]
ROI
region of interest
HIE
hypoxic-ischemic encephalopathy
PEEP
positive end-expiratory pressure
TLV
total liquid ventilation
FRC
functional residual capacity
PFOB
perfluorooctylbromide
PCO2
arterial blood carbon dioxide partial pressure
Hypothermia
Induced
FiO2
inhaled fraction of oxygen
Animals
Therapeutic hypothermia
Lung
ANOVA
analysis of variance
ComputingMilieux_MISCELLANEOUS
EV
expiratory volume of liquid
Fluorocarbons
Rehabilitation
Recovery of Function
respiratory system
Immunohistochemistry
PO2
arterial blood oxygen partial pressure
respiratory tract diseases
Respiratory Function Tests
Macaca fascicularis
TV
tidal volume
Tomography
X-Ray Computed
Biomedical engineering
MRI
magnetic resonance imaging
Zdroj: EBioMedicine
EBioMedicine, Elsevier, 2019, ⟨10.1016/J.EBIOM.2019.08.026⟩
EBioMedicine, 2019, ⟨10.1016/J.EBIOM.2019.08.026⟩
ISSN: 2352-3964
Popis: Background Total liquid ventilation (TLV) of the lungs could provide radically new benefits in critically ill patients requiring lung lavage or ultra-fast cooling after cardiac arrest. It consists in an initial filling of the lungs with perfluorocarbons and subsequent tidal ventilation using a dedicated liquid ventilator. Here, we propose a new paradigm for a lung-conservative TLV using pulmonary volumes of perfluorocarbons below functional residual capacity (FRC). Methods and findings Using a dedicated technology, we showed that perfluorocarbon end-expiratory volumes could be maintained below expected FRC and lead to better respiratory recovery, preserved lung structure and accelerated evaporation of liquid residues as compared to complete lung filling in piglets. Such TLV below FRC prevented volutrauma through preservation of alveolar recruitment reserve. When used with temperature-controlled perfluorocarbons, this lung-conservative approach provided neuroprotective ultra-fast cooling in a model of hypoxic-ischemic encephalopathy. The scale-up and automating of the technology confirmed that incomplete initial lung filling during TLV was beneficial in human adult-sized pigs, despite larger size and maturity of the lungs. Our results were confirmed in aged non-human primates, confirming the safety of this lung-conservative approach. Interpretation This study demonstrated that TLV with an accurate control of perfluorocarbon volume below FRC could provide the full potential of TLV in an innovative and safe manner. This constitutes a new paradigm through the tidal liquid ventilation of incompletely filled lungs, which strongly differs from the previously known TLV approach, opening promising perspectives for a safer clinical translation. Fund ANR (COOLIVENT), FRM (DBS20140930781), SATT IdfInnov (project 273).
Databáze: OpenAIRE
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