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Introduction-PLV has been investigated in a number of laboratory and clinical settings. Those studies demonstrate a general improvement in gas exchange and lung mechanics. We have shown a reduction in early inflammatory events following treatment of experimental acute lung injury (ALI) with PLV. Experimental models frequently do not mimic human disease. Furthermore, the onset of human disease is often more temporally remote than that seen in lab studies. Hydrocarbon aspiration is a clinically important cause of ALI associated with significant morbidity and cost. The timing of onset of injury in hydrocarbon aspiration is usually reliable. We hypothesized that timely intervention with PLV in this clinically relevant model of ALI would reduce the early inflammatory events. Methods-Six NZW rabbits were sedated and the trachea exposed under local anesthesia. The trachea was punctured under direct vision and kerosene (0.15-0.2 cc/kg) was injected. The rabbits were kept in 100% O2 spontaneously breathing until the p aO2 fell below 100 torr. At that point, they were randomized to receive PLV (FC-77, 3M Corp.) or conventional ventilation (CMV). The rabbits were supported with volume expanders and pressors as needed. Following 3 hours support, the animals were sacrificed and lung tissue was frozen at-70°C for subsequent batch analysis. The tissue was homogenized in buffered saline, ultrasonified, freeze thawed and clarified. Protein content was determined by the BCA method. Myeloperoxidase activity (MPO) was determined in the supernatants in conventional fashion with o-dianisidine and H2O2 by spectrophotometry over 1 minute. Blood gases (ABG) were determined throughout the study. Average p aO2 for the last hour is presented. The data were analyzed by t-test. Results- In general, the PLV treated rabbits tended to have a higher paO2. The histologic appearance of the PLV treated lungs indicated less severe injury. Table
Conclusions- Support of hydrocarbon aspiration pneumonitis with PLV in the acute phase appears 1) to improve oxygenation as seen in other models of ALI treated with PLV, and 2) to be associated with lower indices of inflammation and lung injury. We speculate that the lesser degree of inflammation may lead to a less severe clinical course with a correspondingly lower morbidity and improved outcome.
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