Assessing the impacts of total liquid ventilation on left ventricular diastolic function in a model of neonatal respiratory distress syndrome

• Published in: PloS one 2018-01, Vol.13 (1), p.e0191885-e0191885
• Main Authors: Sage, Michaël, Nadeau, Mathieu, Forand-Choinière, Claudia, Mousseau, Julien, Vandamme, Jonathan, Berger, Claire, Tremblay-Roy, Jean-Sébastien, Tissier, Renaud, Micheau, Philippe, Fortin-Pellerin, Étienne
• Format: Article
• Language: English
• Subjects: Animals; Animals, Newborn; Arteries; Biology and Life Sciences; Blood pressure; Cardiac output; Cardiovascular system; Catheters; Diastole; Diastolic pressure; Disease Models, Animal; Echocardiography; Engineering and Technology; Fluorocarbons - pharmacokinetics; Heart; Hemodynamics; Liquid Ventilation - methods; Lungs; Mechanical engineering; Mechanical ventilation; Medical instruments; Medicine and Health Sciences; Myocardium; Neonates; Newborn babies; Pediatrics; Perfluorocarbons; Pharmacology; Physiology; Pulmonary arteries; Pulmonary artery; Relaxation time; Respiration; Respiratory distress syndrome; Respiratory Distress Syndrome, Newborn - physiopathology; Respiratory Distress Syndrome, Newborn - therapy; Sensors; Sheep; Stability analysis; Surfactants; Thorax; Time constant; Ventilation; Ventilators; Ventricle; Ventricular Function, Left
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0191885

Filling the lung with dense liquid perfluorocarbons during total liquid ventilation (TLV) might compress the myocardium, a plausible explanation for the instability occasionally reported with this technique. Our objective is to assess the impacts of TLV on the cardiovascular system, particularly left ventricular diastolic function, in an ovine model of neonatal respiratory distress syndrome. Eight newborns lambs, 3.0 ± 0.4 days (3.2 ± 0.3kg) were used in this crossover experimental study. Animals were intubated, anesthetized and paralyzed. Catheters were inserted in the femoral and pulmonary arteries. A high-fidelity pressure catheter was inserted into the left ventricle. Surfactant deficiency was induced by repeated lung lavages with normal saline. TLV was then conducted for 2 hours using a liquid ventilator prototype. Thoracic echocardiography and cardiac output assessment by thermodilution were performed before and during TLV. Left ventricular end diastolic pressure (LVEDP) (9.3 ± 2.1 vs. 9.2 ± 2.4mmHg, p = 0.89) and dimension (1.90 ± 0.09 vs. 1.86 ± 0.12cm, p = 0.72), negative dP/dt (-2589 ± 691 vs. -3115 ± 866mmHg/s, p = 0.50) and cardiac output (436 ± 28 vs. 481 ± 59ml/kg/min, p = 0.26) were not affected by TLV initiation. Left ventricular relaxation time constant (tau) slightly increased from 21.5 ± 3.3 to 24.9 ± 3.7ms (p = 0.03). Mean arterial systemic (48 ± 6 vs. 53 ± 7mmHg, p = 0.38) and pulmonary pressures (31.3 ± 2.5 vs. 30.4 ± 2.3mmHg, p = 0.61) were stable. As expected, the inspiratory phase of liquid cycling exhibited a small but significant effect on most variables (i.e. central venous pressure +2.6 ± 0.5mmHg, p = 0.001; LVEDP +1.18 ± 0.12mmHg, p