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 |
Externí odkaz: |