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Fluorocarbon Ventilation: Maximal Expiratory Flows and Coz Elimination

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Fluorocarbon Ventilation: Maximal Expiratory Flows and Coz Elimination 003 1-3998/88/2403-029 1$02.00/0 PEDIATRIC RESEARCH Vol. 24, No. 3, 1988 Copyright O 1988 International Pediatric Research Foundation, Inc Printed in U.S.A. Fluorocarbon Ventilation: Maximal Expiratory Flows and COz Elimination PETER A. KOEN, MARLA R. WOLFSON, AND THOMAS H. SHAFFER Temple University School of Medicine, Department of Physiology and Pediatrics, Philadelphia. 19140 and Drexel University, Biomedical Engineering and Science, Philadelphia, Pennsylvania 19104 ABSTRACT. Elimination of C02 during liquid ventilation PVCO,, venous carbon dioxide tension is dependent on flow, diffusion, and the 1.iquid's capacitance PAco,, alveolar carbon dioxide tension for C02. Maximum expiratory flow (V,.,) and diffusion FC-SO, fluorocarbon dead space were measured in vivo in 12 young cats during Paco,, arterial carbon dioxide tension liquid fluorocarbon (FC-80) ventilation to determine the P-, mixed expired carbon dioxide tension effect of breathing frequency on maximum CO2 elimina- V(t), net volume tion. All animals were maintained (Pao, = 255 f 19 SEM MEFV, maximum expiratory flow volume mm Hg, Paco2 = 35 2 1 SEM mm Hg, pH = 7.31 + 0.01 VEmax,maximum expiratory volume SEM) within physiologic range during 1-4 h of liquid TE, expiratory time ventilation. The V,., in air (26 f 1 SEM literlmin) and in VAmnx,maximum predicted alveolar ventilation liquid (1.2 + 0.2 SEM litertmin) was determined by volume Vco2-, maximum predicted carbon dioxide elimination displacement plethysmography. Diffusion dead space VC, vital capacity (V~dif;)during liquid ventilation as a ratio of alveolar vol- Vb lung volume ume (VA) was well correlated (r = 0.84, p c 0.005) with TI, inspiratory time the average time (tav) the liquid was in the lung v~dif;/VA f, frequency - 0.89 (-0.053 tav)1. Alveolar ventilation, C02 elimination (vco,), and Pace, were not affected by breathing frequency (f) when tidal volume was adjusted appropriately during steady state liquid ventilation. Predicted maximum C02 elimination (VcoZmax)determined from V,., and VDdia was Several studies have demonstrated that FC-80 ventilation is a 24 ml/min at a f of 3-3.5 breathslmin. The maximum was feasible alternative to gas ventilation in premature and newborn found to be strongly dependent on f with much less de- experimental animals (1-5). Because the air-liquid interface is pendency on fixed dead space (anatomic plus equipment) abolished in the liquid-filled lung, it has been suggested that this and wave shape characteristics. Elimination of C02 de- elimination of high surface forces could account for effective gas creased at low values off due to inadequate ventilation and exchange and pulmonary stability. Studies have shown that at high values off due to inadequate diffusion time. From inflation pressures are reduced (3, lung compliance is increased a comparison of experimentally determined steady state (1,2, 6), and Pa02 and A-a_D02 are improved (6) in immature Vco, to theoretically predicted VcoZmax,the results demon- lungs after FC-80 ventilation. Although oxygen delivery in these strate a f-related functional reserve capacity for CO2 elim- studies has been effective, carbon dioxide removal has been ination during liquid ventilation. These findings suggest complicated by several factors. that by optimizing the liquid ventilatory pattern it should Maintenance of normal arterial carbon dioxide tension during be possible to maintain adequate CO2 elimination and liquid fluorocarbon ventilation is dependent on the rate limiting physiologic Pace, in the presence of pulmonary dysfunction factors of flow and diffusion (7). The V,,, of liquid from the and/or elevated metabolic states. (Pediatr Res 24: 291- lung is limited by the wave speed of the fluid (8-10). Further- 296,1988) more, diffusion of C02 into FC-80 is approximately 2500 times slower (7) than diffusion of COz in air and is gradient limited (PVco, 1'46 mm Hg and PA^^,= 40 mm Hg). Previous inves- Abbreviations tigators have attempted to quantitate the flow-limiting factor V,,,, maximal expiratory flow from in vitro experiments (7) and the diffusion factor from VD~,,~~,anatomic dead space analytical models (1 I). The objective of the present study is 2- VA, alveolar volume fold: to quantitate each of the rate limiting factors from in vivo VA, alveolar ventilation animal experiments and to use these results to determine analyt- V~din.- ...., diffusion dead mace ically breathing frequencies that will maximize C02 elimination V~~h,.~i.,l,physiologic dead space during fluorocarbon ventilation. tav, average time Vco,, carbon dioxide elimination METHODS A-a boz,alveolar - arterial oxygen difference Animal Preparation. Twelve young cats (weight 2.1 + 0.2 SEM Pao2, arterial oxygen tension kg) were studied after intraperitoneal anesthesia with pentobar- bital sodium (30 mg/kg). The carotid artery was catheterized for Received May 26, 1987; accepted April 20, 1988. blood sampling and a tracheal cannula (4.5 mm OD) was inserted Correspondence and reprint requests P. A. Koen, Ph.D., c/o T. H. Shaffer, Ph.D., Temple University School of Medicine, Department of Physiology, 3420 N. midway a'ong the trachea with its tip positioned the Broad Street, Philadelphia, PA 19 140. carina. A baseline set of data was collected during spontaneous Supported in part by NIH Public Health Grants HL/HD 30525 and 32031. air breathing. Each cat was then mechanically hyperventilated 292 KOEN ET AL. with oxygen for a period of 15 min before the initiation of liquid The volume displacement plethysmograph was constructed breathing. This was done to remove nitrogen from the lung, based on the Mead (13) design from an infant isolette (33 inch elevate oxygen, and depress carbon dioxide tensions. Succinyl- length, 14 inch width, 13 inch height, 0.25 inch thickness) closed choline chloride (2.0 mglkg) was administered after the first few at the bottom by a 1-inch Lucite plate and sealed by neoprene minutes of mechanical ventilation to suppress the animal's own O-rings. Air flow was measured with a 400-mesh stainless steel respiratory movements. Additional amounts of succinylcholine screen pneumotachograph similar to the Lilly (14) design. The chloride were administered during the remainder of the study pressure drop across the screen was measured with a Statham when the animals made spontaneous efforts to breathe. PM 197 differential pressure transducer, with the resulting signal Liquid ventilation procedure. Liquid ventilation with FC-80 pressure corrected (15) and recorded on the Grass model 7 was achieved using a previously described but modified liquid polygraph. The pneumotachograph was tested and found to have breathing system (4, 12), The apparatus basically consists of linear pressure flow characteristics up to 30 literlmin. bellow pumps and associated valving such that the FC-80 is both The undamped natural frequency of the plethysmograph was pumped into and evacuated from the lungs of the animal. A 6.4 Hz with a damping ratio of 0.7. These values were determined volume of warmed (37" C), oxygenated liquid, equivalent to the by rapidly pushing air into the plethysmograph. The displace- animal's estimated functional residual capacity (30 mllkg) was ment recording was then analyzed by the method indicated by then removed from the liquid breathing system. This volume Fry (16). Volume was measured with a bell-type spirometer. The was instilled into the animal's lungs via the tracheostomy tube maximum hysteresis error of the spirometer was less than 3% from a suspended reservoir. Postural and thoracic manipulations with tidal volumes less than 100 ml. The undamped natural were performed to force out any large pockets of oxygen that frequency of the spirometer was 3.7 Hz with a damping ratio of may have become trapped in the lungs. The animal's tracheal 0.48. tube was then connected to the liquid breathing system. Experimental Procedure. The rate-limiting factors of diffusion A rectal thermocouple (Yellow Springs Instruments, Yellow and expiratory flow were examined separately in two series of Springs, OH) was inserted for constant monitoring of the ani- experiments. V~~h~~i~lwas calculated during both air and liquid mal's core body temperature. Arterial blood gases as well as breathing using the Enghoff (17) modification of the Bohr equa- fluorocarbon gases were analyzed using a Radiometer electrode tion. After the cat was cannulated, VD~~~~~~Iwas calculated by system. recording Paco,and PE~,as measured with a C02gas analyzer Measuring apparatus. Animal weight and flow during liquid (Godart Type KK) while air breathing. V~~h~~i~lduring air breath- breathing were measured by the experimental apparatus shown ing was assumed to be equal to VD,,, as occurs in normal animals in Figure 1. The weight platform is supported by three force (18). V~~h~~i~lspace during liquid breathing was similarly calcu- transducers (Grass model FTO1 C); electrical signals from which lated with PEC02being determined from mixed expiratory FC-80. are summed and fed into a polygraph recorder (Grass model 7). These samples were taken from a port in the liquid breathing With an animal weight of 1 kg the system has a natural frequency system sufficiently downstream (7 feet of 2 inch diameter tubing of 14 Hz with a damping ratio of 0.0 19. The drift error after 3% with three 90" trns) from the animal such that complete mixing h is less than 7 g (approximately 4 ml' of FC-80). of C02 had occurred. Vwia during liquid breathing (19) which SPIROMETER \ PNEUMOTACHOGRAPH -......-- SOLETTE ATTACHMENT'. COMPRESSION TRANSDUCER Fig. 1. Schematic of the weight platform and volume displacement plethysmograph. The weight platform is supported by three force transducers: two at the head-end and one at the tail-end. For purposes of illustration only two of the transducers are shown. COz ELIMINATION DURIl'JG LIQUID VENTILATION 293 results from persisting gradients of gas tension in the lung was analyses were performed by the least squares method.
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