Total liquid ventilation can support gas exchange in animal models of lung injury. Clinical application awaits further technical improvements and performance verification. Our aim was to develop a liquid ventilator, able to deliver accurate tidal volumes, and a computerized system for measuring lung mechanics. The computer-assisted, piston-driven respirator controlled ventilatory parameters that were displayed and modified on a real-time basis. Pressure and temperature transducers along with a lineal displacement controller provided the necessary signals to calculate lung mechanics. Ten newborn lambs (<6 days old) with respiratory failure induced by lung lavage, were monitored using the system. Electromechanical, hydraulic and data acquisition/analysis components of the ventilator were developed and tested in animals with respiratory failure. All pulmonary signals were collected synchronized in time, displayed in real-time, and archived on digital media. The total mean error (due to transducers, A/D conversion, amplifiers, etc.) was less than 5% compared to calibrated signals. Improvements in gas exchange and lung mechanics were observed during liquid ventilation, without impairment of cardiovascular profiles. The total liquid ventilator maintained accurate control of tidal volumes and the sequencing of inspiration/expiration. The computerized system demonstrated its ability to monitor in vivo lung mechanics, providing valuable data for early decision-making.
[1] C. L. Leach, J. S. Greenspan, S. D. Rubenstein, T. H. Shaffer, M. R.
Wolfson, J. C. Jackson, R. DeLemos, B. P. Furhman and Liquivent
Study Group, "Partial liquid ventilation with perflubron in premature
infants with severe respiratory distress syndrome," N. Engl. J. Med., vol.
335, pp. 761-767, 11. 1996.
[2] J. S. Greenspan, W. W. Fox, S. D. Rubenstein, M. R. Wolfson, S. S.
Spinner, T. H. Shaffer and Liquivent Study Group, "Partial liquid
ventilation in critically ill infants receiving extracorporeal life support,"
Pediatrics, vol. 99, pp. e2, 1. 1997.
[3] V. K. Bhutani, "Pulmonary function profile: computer analysis and
pulmonary graphics," in Neonatal Pulmonary Function Testing:
Physiological, Technical and Clinical Considerations, V. K. Bhutani, T.
H. Shaffer and D. Vidyasagar, Ed., 1st ed. Ithaca, N.Y.: Perinatology
Press, 1988, pp. 13-33.
[4] V. K. Bhutani, E. M. Sivieri, S. Abbasi and T. H. Shaffer, "Evaluation of
neonatal pulmonary mechanics and energetics: a two factor least mean
square analysis," Pediatr. Pulmonol., vol. 4, pp. 150-158, 1988.
[5] M. R. Wolfson, J. S. Greenspan, K. S. Deoras, S. D. Rubenstein and T.
H. Shaffer, "Comparison of gas and liquid ventilation: clinical,
physiological, and histological correlates," J. Appl. Physiol., vol. 72, pp.
1024-1031, 3. 1992.
[6] S. E. Curtis, B. P. Fuhrman and D. F. Howland, "Airway and alveolar
pressures during perfluorocarbon breathing in infants lambs," J. Appl.
Physiol., vol. 68, pp. 2322-2328, 6. 1990.
[7] W. H. Matthews, R. H. Balzer, J. D. Shelburne, P. C. Pratt and J. A.
Kylstra, "Steady-state gas exchange in normothermic, anesthetized,
liquid-ventilated dogs," Undersea Biomed. Res., vol. 5, pp. 341-354, 4.
1978.
[8] D. B. Kimless-Garber, M. R. Wolfson, C. Carlsson and T. H. Shaffer,
"Halothane administration during liquid ventilation," Respir. Med., vol.
91, pp. 255-262, 5. 1997.
[9] A. Valls-i-Soler, M. A. Gomez, E. Gastiasoro and F. J. Alvarez,
"Perfluorocarbon liquid ventilation," in Proc. XV European Congress of
Perinatal Medicine, 1996, pp. 250-256.
[10] M. R. Wolfson, N. Tran, V. K. Bhutani and T. H. Shaffer, "A new
experimental approach for the study of cardiopulmonary physiology
during early development," J. Appl. Physiol., vol. 65, pp. 1436-1443, 3.
1988.
[11] R. B. Hirschl, S. I. Merz, P. Montoya, A. Parent, M. W. Wolson, T. H.
Shaffer and R. H. Bartlett, "Development and application of a simplified
liquid ventilator," Crit. Care Med., vol. 23, pp. 157-163, 1. 1995.
[12] J.L. Larrabe, F.J. Alvarez, E. Gastiasoro, L.F. Alfonso, A. Arnaiz, M.B.
Fernandez, B. Loureiro, A. Valls-i-Soler, N.G. Publicover, L. Roman,
J.A. Casla, M.A. Gomez. "Development of a time-cycled, volumecontrolled
respirator and lung mechanics system for total liquid
ventilation". IEEE Tran. Biomed. Eng., vol. 48, pp. 1134-1144, 2001
[13] S. Z. Turney, T. C. McAslan and R. A. Cowley, "The continuous
measurement of pulmonary gas exchange and mechanics," Ann. Thorac.
Surg., vol. 13, pp. 229-242, 1972.
[14] W. Nikischin, T. Gerhardt, R. Everett and E. Bancalari, "A new method
to analyze lung compliance when pressure-volume relationship is
nonlinear," Am. J. Respir. Crit. Care Med., vol. 158, pp. 1052-1060,
1998.
[15] K. Roske, B. Foitzik, R. R. Wauer and G. Schmalisch, "Accuracy of
volume measurements in mechanically ventilated newborns: a
comparative study of commercial devices," J. Clin. Monit., vol. 14, pp.
413-420, 1998.
[16] E. Gastiasoro, F. J. Alvarez, A. Arnaiz, B. Fernandez, J. Lopez-Heredia,
L. F. Alfonso and A. Valls, "Transient response to inhaled nitric oxide in
meconium aspiration in newborn lambs," Pediatr. Res., vol. 43, pp. 198-
202, 2. 1998.
[17] M. Sydow, H. Burchardi, E. Ephraim, S. Zielmann and T. A. Crozier,
"Long-term effects of two different ventilatory modes on oxigenation in
acute lung injury," Am. J. Respir. Crit. Care Med., vol. 149, pp. 1550-
1556, 1994.
[18] F. J. Alvarez, L. F. Alfonso, E. Gastiasoro, J. L├│pez-Heredia, A. Arnaiz
and A. Valls-i-Soler, "The effects of multiple small doses of exogenous
surfactant on experimental respiratory failure induced by lung lavage in
rats," Acta Anaesthesiol. Scand., vol. 39, pp. 970-974, 1995.
[19] P. A. Koen, M. R. Wolfson and T. H. Shaffer, "Fluorocarbon
ventilation: maximal expiratory flows and CO2 elimination," Pediatr.
Res., vol. 24, pp. 291-296, 3. 1988.
[20] J. L. Heckman, J. Hoffman, T. H. Shaffer and M. R. Wolfson, "Software
for real-time control of a tidal liquid ventilator," Biomed. Instrum.
Technol., vol. 33, pp. 268-276, 3. 1999.
[21] B. Lachmann, B. Robertson and J. Vogel, "In vivo lung lavage as an
experimental model of the respiratory distress syndrome," Acta
Anaesthesiol. Scand., vol. 24, pp. 231-236, 1980.
[22] T. H. Shaffer, D. Rubenstein, G. D. Moskowitz and M. Delivoria-
Papadopoulos, "Gaseous exchange and acid-base balance in premature
lambs during liquid ventilation since birth," Pediatr. Res., vol. 10, pp.
227-231, 1976.
[23] R. B. Hirschl, R. Tooley, A. Parent, K. Johnson and R. H. Bartlett,
"Evaluation of gas exchange, pulmonary compliance, and lung injury
during total and partial liquid ventilation in the acute respiratory distress
syndrome," Crit. Care Med., vol. 24, pp. 1001-1008, 6. 1996.
[24] T. H. Shaffer, P. R. Douglas, C. A. Lowe and V. K. Bhutani, "The
effects of liquid ventilation on cardiopulmonary function in preterm
lambs," Pediatr. Res., vol. 17, pp. 303-306, 1983.
[25] R. B. Hirschl, A. Parent, R. Tooley, M. McCracken, K. Johnson, T. H.
Shaffer, M. W. Wolson and R. H. Bartlett, "Liquid ventilation improves
pulmonary function, gas exchange, and lung injury in a model of
respiratory failure," Ann. Surg., vol. 221, pp. 79-88, 1. 1995.
[1] C. L. Leach, J. S. Greenspan, S. D. Rubenstein, T. H. Shaffer, M. R.
Wolfson, J. C. Jackson, R. DeLemos, B. P. Furhman and Liquivent
Study Group, "Partial liquid ventilation with perflubron in premature
infants with severe respiratory distress syndrome," N. Engl. J. Med., vol.
335, pp. 761-767, 11. 1996.
[2] J. S. Greenspan, W. W. Fox, S. D. Rubenstein, M. R. Wolfson, S. S.
Spinner, T. H. Shaffer and Liquivent Study Group, "Partial liquid
ventilation in critically ill infants receiving extracorporeal life support,"
Pediatrics, vol. 99, pp. e2, 1. 1997.
[3] V. K. Bhutani, "Pulmonary function profile: computer analysis and
pulmonary graphics," in Neonatal Pulmonary Function Testing:
Physiological, Technical and Clinical Considerations, V. K. Bhutani, T.
H. Shaffer and D. Vidyasagar, Ed., 1st ed. Ithaca, N.Y.: Perinatology
Press, 1988, pp. 13-33.
[4] V. K. Bhutani, E. M. Sivieri, S. Abbasi and T. H. Shaffer, "Evaluation of
neonatal pulmonary mechanics and energetics: a two factor least mean
square analysis," Pediatr. Pulmonol., vol. 4, pp. 150-158, 1988.
[5] M. R. Wolfson, J. S. Greenspan, K. S. Deoras, S. D. Rubenstein and T.
H. Shaffer, "Comparison of gas and liquid ventilation: clinical,
physiological, and histological correlates," J. Appl. Physiol., vol. 72, pp.
1024-1031, 3. 1992.
[6] S. E. Curtis, B. P. Fuhrman and D. F. Howland, "Airway and alveolar
pressures during perfluorocarbon breathing in infants lambs," J. Appl.
Physiol., vol. 68, pp. 2322-2328, 6. 1990.
[7] W. H. Matthews, R. H. Balzer, J. D. Shelburne, P. C. Pratt and J. A.
Kylstra, "Steady-state gas exchange in normothermic, anesthetized,
liquid-ventilated dogs," Undersea Biomed. Res., vol. 5, pp. 341-354, 4.
1978.
[8] D. B. Kimless-Garber, M. R. Wolfson, C. Carlsson and T. H. Shaffer,
"Halothane administration during liquid ventilation," Respir. Med., vol.
91, pp. 255-262, 5. 1997.
[9] A. Valls-i-Soler, M. A. Gomez, E. Gastiasoro and F. J. Alvarez,
"Perfluorocarbon liquid ventilation," in Proc. XV European Congress of
Perinatal Medicine, 1996, pp. 250-256.
[10] M. R. Wolfson, N. Tran, V. K. Bhutani and T. H. Shaffer, "A new
experimental approach for the study of cardiopulmonary physiology
during early development," J. Appl. Physiol., vol. 65, pp. 1436-1443, 3.
1988.
[11] R. B. Hirschl, S. I. Merz, P. Montoya, A. Parent, M. W. Wolson, T. H.
Shaffer and R. H. Bartlett, "Development and application of a simplified
liquid ventilator," Crit. Care Med., vol. 23, pp. 157-163, 1. 1995.
[12] J.L. Larrabe, F.J. Alvarez, E. Gastiasoro, L.F. Alfonso, A. Arnaiz, M.B.
Fernandez, B. Loureiro, A. Valls-i-Soler, N.G. Publicover, L. Roman,
J.A. Casla, M.A. Gomez. "Development of a time-cycled, volumecontrolled
respirator and lung mechanics system for total liquid
ventilation". IEEE Tran. Biomed. Eng., vol. 48, pp. 1134-1144, 2001
[13] S. Z. Turney, T. C. McAslan and R. A. Cowley, "The continuous
measurement of pulmonary gas exchange and mechanics," Ann. Thorac.
Surg., vol. 13, pp. 229-242, 1972.
[14] W. Nikischin, T. Gerhardt, R. Everett and E. Bancalari, "A new method
to analyze lung compliance when pressure-volume relationship is
nonlinear," Am. J. Respir. Crit. Care Med., vol. 158, pp. 1052-1060,
1998.
[15] K. Roske, B. Foitzik, R. R. Wauer and G. Schmalisch, "Accuracy of
volume measurements in mechanically ventilated newborns: a
comparative study of commercial devices," J. Clin. Monit., vol. 14, pp.
413-420, 1998.
[16] E. Gastiasoro, F. J. Alvarez, A. Arnaiz, B. Fernandez, J. Lopez-Heredia,
L. F. Alfonso and A. Valls, "Transient response to inhaled nitric oxide in
meconium aspiration in newborn lambs," Pediatr. Res., vol. 43, pp. 198-
202, 2. 1998.
[17] M. Sydow, H. Burchardi, E. Ephraim, S. Zielmann and T. A. Crozier,
"Long-term effects of two different ventilatory modes on oxigenation in
acute lung injury," Am. J. Respir. Crit. Care Med., vol. 149, pp. 1550-
1556, 1994.
[18] F. J. Alvarez, L. F. Alfonso, E. Gastiasoro, J. L├│pez-Heredia, A. Arnaiz
and A. Valls-i-Soler, "The effects of multiple small doses of exogenous
surfactant on experimental respiratory failure induced by lung lavage in
rats," Acta Anaesthesiol. Scand., vol. 39, pp. 970-974, 1995.
[19] P. A. Koen, M. R. Wolfson and T. H. Shaffer, "Fluorocarbon
ventilation: maximal expiratory flows and CO2 elimination," Pediatr.
Res., vol. 24, pp. 291-296, 3. 1988.
[20] J. L. Heckman, J. Hoffman, T. H. Shaffer and M. R. Wolfson, "Software
for real-time control of a tidal liquid ventilator," Biomed. Instrum.
Technol., vol. 33, pp. 268-276, 3. 1999.
[21] B. Lachmann, B. Robertson and J. Vogel, "In vivo lung lavage as an
experimental model of the respiratory distress syndrome," Acta
Anaesthesiol. Scand., vol. 24, pp. 231-236, 1980.
[22] T. H. Shaffer, D. Rubenstein, G. D. Moskowitz and M. Delivoria-
Papadopoulos, "Gaseous exchange and acid-base balance in premature
lambs during liquid ventilation since birth," Pediatr. Res., vol. 10, pp.
227-231, 1976.
[23] R. B. Hirschl, R. Tooley, A. Parent, K. Johnson and R. H. Bartlett,
"Evaluation of gas exchange, pulmonary compliance, and lung injury
during total and partial liquid ventilation in the acute respiratory distress
syndrome," Crit. Care Med., vol. 24, pp. 1001-1008, 6. 1996.
[24] T. H. Shaffer, P. R. Douglas, C. A. Lowe and V. K. Bhutani, "The
effects of liquid ventilation on cardiopulmonary function in preterm
lambs," Pediatr. Res., vol. 17, pp. 303-306, 1983.
[25] R. B. Hirschl, A. Parent, R. Tooley, M. McCracken, K. Johnson, T. H.
Shaffer, M. W. Wolson and R. H. Bartlett, "Liquid ventilation improves
pulmonary function, gas exchange, and lung injury in a model of
respiratory failure," Ann. Surg., vol. 221, pp. 79-88, 1. 1995.
@article{"International Journal of Medical, Medicine and Health Sciences:55717", author = "Miguel A. Gómez and Enrique Hilario and Francisco J. Alvarez and Elena Gastiasoro and Antonia Alvarez and Juan L. Larrabe", title = "Respirator System For Total Liquid Ventilation", abstract = "Total liquid ventilation can support gas exchange in animal models of lung injury. Clinical application awaits further technical improvements and performance verification. Our aim was to develop a liquid ventilator, able to deliver accurate tidal volumes, and a computerized system for measuring lung mechanics. The computer-assisted, piston-driven respirator controlled ventilatory parameters that were displayed and modified on a real-time basis. Pressure and temperature transducers along with a lineal displacement controller provided the necessary signals to calculate lung mechanics. Ten newborn lambs (", keywords = "immature lamb, perfluorocarbon, pressure-limited, total liquid ventilation, ventilator; volume-controlled", volume = "1", number = "11", pages = "572-6", }
