Experimental study of high frequency oscillatory ventilation combined with exogenous pulmonary surfactant for the treatment of acute lung injury with acute respiratory failure induced by vapour inhalation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Shaogen ^1# ,  GUO Guanghua ¹ , FU Zhonghua ¹ , ZhOU Sifang ²

Burn Center，First Affiliated Hospital of Nanchang University.Nanchang，Jiangxi，330006，ChinaCorresponding author：GUO Guang-hua，E-mail：guogh2000@hotmail.com;

Corresponding author：

GUO Guanghua, Email: guogh2000@hotmail.com

Keywords：

High frequency oscillatory ventilation; Conventional mandatory ventilation; Pulmonary surfactant; Inhalation injury

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Objective To compare the effects of high frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) whith or without pulmonary surfactant(PS) supplement on water vapour inhalation injury.Methods New Zealand rabbits model of severe acute lung injury with acute respiratory failure caused by steam inhalation was established.Then the animals were treated by CMV，HFOV，CMV+PS or HFOV+PS，respectively while animals in control group did not ventilated and supplemented with PS.Femoral arterial blood samples were obtained at 1，2，3，4 h after treatment for blood gas analysis.4 h after treatment ,the lowest lobe of right lung was weighed for calculating wet-to-dry weight ratio (W/D).Four different parts including dependent areas and non-dependent areas of the middle lobe of right lung were excised for histological observation.Results (A) After ALI established PaO2 in the five groups decreased below 60mmHg (P lt;0.01) but intergroup differences were found.Meanwhile the change of PaCO2 showd no statistical significance(P gt;0.05).(B) PaO2 in the four treatment groups had increased since one hour after treatmentand sustained at favorite levels during treatment period.PaO2 in the HFOV and HFOV+PS groups were higher than those in CMV and CMV+PS groups,respectively (P lt;0.01，P lt;0.05).PaO2 in the CMV+PS group at 2 h and HFOV+PS group at 2 h and 3 h were significantly higher than those in corresponding non-PS groups at the same timepoints (P lt;0.05).P（A-a）O2 in the HFOV and HFOV+PS groups were lower than those in CMV and CMV+PS groups (P lt;0.05).P（A-a）O2 in the two groups with PS at 2 h，3 h and 4 h t were statistically lower than those in the two corresponding groups without PS (P lt;0.05).The pH and PaCO2 as well as circulatory function in the four groups were not significantly different at different treatment timepoints (P gt;0.05).(C) Lung W/D was not different between CMV and HFOV groups (P gt;0.05)，or CMV+PS and HFOV+PS.But lung W/D in the two groups treated with PS showed statistically decrement than that in non-PS groups (P lt;0.05).(D) Histological injury score was lowest in HFOV+PS group and highest in CMV group.Conclusion HFOV combined with exogenous PS supplement can improve arterial oxygenation and alleviate pulmonary edema and injury，which may be a optimal method for the treatment of acute lung injury with acute respiratory failure caused by water vapour inhalation.

Citation： WANG Shaogen,GUO Guanghua,FU Zhonghua,ZhOU Sifang. Experimental study of high frequency oscillatory ventilation combined with exogenous pulmonary surfactant for the treatment of acute lung injury with acute respiratory failure induced by vapour inhalation. Chinese Journal of Respiratory and Critical Care Medicine, 2007, 6(1): 39-44. doi: Copy

1.	杨宗城.吸入性损伤研究进展.中华烧伤杂志，2000，16：137-140.
2.	Rotta AT，Gunnarsson B，Fuhrman BP，et al.Comparison of lung protective ventilation strategies in a rabbit model of acute lung injury.Crit Care Med，2001，29：2176-2184.
3.	刘志远，黎鳌，杨宗城.兔呼吸道蒸汽烧伤后肺表面活性物质的变化.第三军医大学学报，1984，6：1-7.
4.	谢尔凡，杨宗城，黎鳌.肺灌洗及外源性表面活性物质治疗烟雾吸入性损伤的实验研究.中华外科杂志，1997，35：745-748.
5.	杨波，罗奇志，闫乔生.应用肺表面活性物质治疗重度吸入性损伤六例.中华烧伤杂志，2003，19：368.
6.	Lewis J，McCaig L，Hafner D，et al.Dosing and delivery of a recombinant surfactant in lung injury adult sheep.Am J Respir Crit Care Med，1999，159：741-747.
7.	Ikegami M，Wada K，Emerson GA，et al.Effects of ventilation style on surfactant metabolism and treatment response in preterm lambs.Am J Respir Crit Care Med，1998，157：638-644.
8.	Plavka R，Keszler M.Interaction between surfactant and ventilatory support in newborns with primary surfactant deficiency.Biol Neonate，2003，84：89-95.
9.	Plavka R，Kopecky P，Sebron V，et al.Early versus delayed surfactant adminstration in extremely premature neonates with repiratory distress syndrome ventilated by high-frequency oscillatory ventilation.Intensive Care Med，2002，28：1483-1490.
10.	Van Kaam AH，Haitsma JJ，Dik WA，et al.Response to exogenous surfactant is different during open lung and conventional ventilation.Crit Care Med，2004，32：774-780.
11.	Slutsky AS.Ventilator-induced lung injury：From barotraumas to biotrauma.Respir Care，2005，50：646-659.
12.	宋鹏，李琦，王长征，等.17例重症急性呼吸窘迫综合征临床资料回顾性分析.中国呼吸与危重监护杂志，2006，5：35-38.
13.	俞森洋.重视对急性呼吸窘迫综合征肺保护性通气策略的研究和应用.中国呼吸与危重监护杂志，2002，1：193-196.
14.	von der Hardt K，Kandler MA，Fink L，et al.High frequency oscillatory ventilation suppresses inflammatory response in lung tissue and microdissected alveolar macrophages in surfactant depleted piglets.Pediatr Res，2004，55：339-346.
15.	Ito Y，Manwell SE，Kerr CL，et al.Effects of ventilation strategies on the efficacy of exogenous surfactant therapy in a rabbit model of acute lung injury.Am J Respir Crit Care Med，1998，157：149-155.
16.	van Kaam AH，Dik WA，Haitsma JJ，et al.Application of the open-lung concept during positive-pressure ventilation reduces pulmonary inflammation in newborn piglets.Bio Neonate，2003，83：273-280.
17.	Joseph CA, Robert CM, Christopher AD, et al.Effect of ventilation rate on intilled surfactant distribution in the pulmonary airways of rat.J Appl Physiol, 2004,97:45-46.
18.	Naill DF, Thomas ES.New therapies for adults with acute lung injury-high frequency oscillatory ventilation.Crit Care Clin,2002,18:91-106.
19.	Veldhuizen RA，Inchley K，Hearn SA，et al.Degradation of surfactant-associated protein B(SP-B) during in vitro conversion of large to small surfactant aggregates.Biochem J，1993，295：141-147.
20.	郑华飞，刘远志，杨宗城.家兔烟雾吸入性损伤早期肺表面活性物质存在形式的改变及意义.中华烧伤杂志，2004，20：362-364.
21.	Imai Y，Nakagawa S，Ito Y，et al.Comparison of lung protective strategies using conventional and high-frequency oscillatory ventilation.J Appl Physiol，2001，91：1836-1844.
22.	Frerking I，Gunther A，Seeger W，et al.Pulmonary surfactant：function，abnormalities and therapeutic options.Intensive Care Med，2001，27：1699-1717.

1. 杨宗城.吸入性损伤研究进展.中华烧伤杂志，2000，16：137-140.
2. Rotta AT，Gunnarsson B，Fuhrman BP，et al.Comparison of lung protective ventilation strategies in a rabbit model of acute lung injury.Crit Care Med，2001，29：2176-2184.
3. 刘志远，黎鳌，杨宗城.兔呼吸道蒸汽烧伤后肺表面活性物质的变化.第三军医大学学报，1984，6：1-7.
4. 谢尔凡，杨宗城，黎鳌.肺灌洗及外源性表面活性物质治疗烟雾吸入性损伤的实验研究.中华外科杂志，1997，35：745-748.
5. 杨波，罗奇志，闫乔生.应用肺表面活性物质治疗重度吸入性损伤六例.中华烧伤杂志，2003，19：368.
6. Lewis J，McCaig L，Hafner D，et al.Dosing and delivery of a recombinant surfactant in lung injury adult sheep.Am J Respir Crit Care Med，1999，159：741-747.
7. Ikegami M，Wada K，Emerson GA，et al.Effects of ventilation style on surfactant metabolism and treatment response in preterm lambs.Am J Respir Crit Care Med，1998，157：638-644.
8. Plavka R，Keszler M.Interaction between surfactant and ventilatory support in newborns with primary surfactant deficiency.Biol Neonate，2003，84：89-95.
9. Plavka R，Kopecky P，Sebron V，et al.Early versus delayed surfactant adminstration in extremely premature neonates with repiratory distress syndrome ventilated by high-frequency oscillatory ventilation.Intensive Care Med，2002，28：1483-1490.
10. Van Kaam AH，Haitsma JJ，Dik WA，et al.Response to exogenous surfactant is different during open lung and conventional ventilation.Crit Care Med，2004，32：774-780.
11. Slutsky AS.Ventilator-induced lung injury：From barotraumas to biotrauma.Respir Care，2005，50：646-659.
12. 宋鹏，李琦，王长征，等.17例重症急性呼吸窘迫综合征临床资料回顾性分析.中国呼吸与危重监护杂志，2006，5：35-38.
13. 俞森洋.重视对急性呼吸窘迫综合征肺保护性通气策略的研究和应用.中国呼吸与危重监护杂志，2002，1：193-196.
14. von der Hardt K，Kandler MA，Fink L，et al.High frequency oscillatory ventilation suppresses inflammatory response in lung tissue and microdissected alveolar macrophages in surfactant depleted piglets.Pediatr Res，2004，55：339-346.
15. Ito Y，Manwell SE，Kerr CL，et al.Effects of ventilation strategies on the efficacy of exogenous surfactant therapy in a rabbit model of acute lung injury.Am J Respir Crit Care Med，1998，157：149-155.
16. van Kaam AH，Dik WA，Haitsma JJ，et al.Application of the open-lung concept during positive-pressure ventilation reduces pulmonary inflammation in newborn piglets.Bio Neonate，2003，83：273-280.
17. Joseph CA, Robert CM, Christopher AD, et al.Effect of ventilation rate on intilled surfactant distribution in the pulmonary airways of rat.J Appl Physiol, 2004,97:45-46.
18. Naill DF, Thomas ES.New therapies for adults with acute lung injury-high frequency oscillatory ventilation.Crit Care Clin,2002,18:91-106.
19. Veldhuizen RA，Inchley K，Hearn SA，et al.Degradation of surfactant-associated protein B(SP-B) during in vitro conversion of large to small surfactant aggregates.Biochem J，1993，295：141-147.
20. 郑华飞，刘远志，杨宗城.家兔烟雾吸入性损伤早期肺表面活性物质存在形式的改变及意义.中华烧伤杂志，2004，20：362-364.
21. Imai Y，Nakagawa S，Ito Y，et al.Comparison of lung protective strategies using conventional and high-frequency oscillatory ventilation.J Appl Physiol，2001，91：1836-1844.
22. Frerking I，Gunther A，Seeger W，et al.Pulmonary surfactant：function，abnormalities and therapeutic options.Intensive Care Med，2001，27：1699-1717.

Chinese Journal of Respiratory and Critical Care Medicine

Experimental study of high frequency oscillatory ventilation combined with exogenous pulmonary surfactant for the treatment of acute lung injury with acute respiratory failure induced by vapour inhalation

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