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Peritoneal Perfusion With Oxygenated Perfluorocarbon Augments Systemic Oxygenation^*

^* From the Department of Surgery (Drs. Carr, Cantor, and Friedberg, and Mr. Collins), University of Pennsylvania; and the Department of Surgery (Drs. Rao and Lakshman), Thomas Jefferson University, Philadelphia, PA.

Correspondence to: Joseph S. Friedberg, MD, Chief, Division of Thoracic Surgery, Penn-Presbyterian Medical Center, University of Pennsylvania, 51 N Thirty-Ninth St, 266 Wright-Saunders, Philadelphia, PA 19104; e-mail: Joseph.Friedberg{at}uphs.upenn.edu

Abstract

Background: Despite maximal ventilatory support, many patients die from hypoxia in the setting of potentially reversible pulmonary failure. There remains a pressing need for additional pulmonary supportive care measures, especially techniques that do not require systemic anticoagulation. The objective of our experiments was to determine whether systemic oxygenation could be increased in a large animal, with induced hypoxia, by perfusing the abdominal cavity with oxygenated perfluorocarbons.

Methods: Fifteen pigs with a mean (± SD) weight of 45 ± 5 kg were intubated and rendered hypoxic by ventilating them with a blend of nitrogen and oxygen to achieve subatmospheric concentrations of inspired oxygen ranging from 18 to 10%, resulting in baseline mean PaO₂ range of 65.9 ± 9.7 to 26.6 ± 2.8 mm Hg, respectively. Peritoneal perfusion was performed in eight animals with oxygenated perfluorocarbon and in seven control animals with oxygenated saline solution.

Results: The average increase in PaO₂ with oxygenated perfluorocarbon perfusion, compared to oxygenated saline solution perfusion, ranged from 8.1 to 18.2 mm Hg. A common treatment effect was estimated across all fraction of inspired oxygen (FIO₂) values, representing the average mean difference in oxygen uptake between oxygenated perfluorocarbon and saline solution, irrespective of the level of FIO₂. This average was 12.8 mm Hg (95% confidence interval, 7.4 to 18.2; p < 0.001). The most clinically relevant results occurred at an FIO₂ of 14%, resulting in a baseline mean PaO₂ of 39.4 ± 5.0 mm Hg with oxygenated saline solution perfusion, and a mean PaO₂ of 55.3 ± 7.6 mm Hg with oxygenated perfluorocarbon perfusion. This corresponded to an increase in arterial oxygen saturation from 73 to 89%.

Conclusion: These results of our principle experiments demonstrate that the peritoneal cavity can be used for gas exchange and, in our model, yielded clinically relevant increases in systemic arterial oxygen levels. This technique may have the potential for the supportive care of patients dying from hypoxia in the setting of reversible lung injury.

Key Words: animals • ARDS • artificial respiration • extracorporeal membrane oxygenation • fluorocarbons • respiratory insufficiency