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Vol. 27, Art. 9 (pp. 230-257)    |    2026       

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Use of liquid ventilation for the treatment of toxic pulmonary edema

Evgeny U. Bonitenko1, Nikolai R. Isabekov1, Anton A. Tonshin1, Arthur F. Makarov1, Michael A. Kotsky1, Alexander A. Kanibolotsky1, Anatoly L. Kovtun2, Anatoly M. Bala2, Julia V. Tkachuk1, Margarita P. Muravskaya1, Natalia V. Blintsova1,
Anatoly Yu. Shishkov1

1Federal State Budgetary Scientific Institution «Scientific Izmerov Research Institute of Occupational Medicine», Budyonny Ave., 31, Moscow, 105275
2 Advanced Research Foundation, Berezhkovskaya embankment, 22,
building 3, Moscow, 121059

Brief summary

Toxic pulmonary edema (TPE), which is the terminal stage of acute respiratory distress syndrome (ARDS) of toxic origin, is accompanied by pronounced disorders of gas exchange and high mortality even with the use of modern methods of intensive care. Traditional respiratory support for severe ARDS is based on the use of mechanical ventilation (MV) with a high concentration of oxygen in the respiratory gas mixture (FiO₂) and positive end-expiratory pressure (PEEP), but in some cases it is not effective. Full liquid lung ventilation (TLV) using perfluorocarbon (PFC) liquids is of particular interest, but its effectiveness in terminal forms of TOL remains insufficiently studied. The goal of the study to assess the prospects for the use of total fluid ventilation for the treatment of the alveolar stage of toxic pulmonary edema. Materials and methods. The study was carried out on Wiesenau minipigs of both sexes at the age of 6-8 months. TPE was simulated by endotracheal (e/t) injection of 0.1H hydrochloric acid (HCl) solution at a dose of 15.0 ml/kg of body weight. After a decrease of the oxygenation index (OI) below 70 mm Hg the animals were randomized into two groups: control and experimental. The animals of the control group were ventilated in the volume control mode (VCM) with the following parameters. In turn, the animals of the experimental group underwent normothermic TLV with perfluorodecalin in the VCV mode for 60 min with the following parameters. The parameters of the acid-base state (ABS), arterial blood gas composition, systemic hemodynamics, survival time, as well as morphological changes in the lungs were assessed. The resalts. In the control group, against the background of mechanical ventilation, a rapid increase in hypoxemia and hemodynamic disorders was noted, leading to the development of a fatal outcome. In turn, in the experimental group, including due to the removal of edema fluid from the respiratory tract, during TLV, an improvement in oxygenation and stabilization of hemodynamic parameters were observed. At the same time, during the TLV process, a gradual increase in the partial pressure of carbon dioxide in the arterial blood was noted, indicating insufficiently effective ventilation. The average time of death and survival time in the alveolar stage of edema in the experimental group were significantly (p <0.05) higher compared to the control by 1.64 and 5.92 times, respectively. Conclusions. The use of normothermic TLV, in contrast to mechanical ventilation, due to the removal of edema fluid from the respiratory tract increases the surface area of oxygen diffusion through the alveolar-capillary membrane, which leads to a decrease in the severity of hypoxemia and, as a consequence, increases the average time to death by more than 1.5 times and the survival time in the alveolar stage of edema by more than 5 times compared to the control.


Key words

Toxic pulmonary edema; acute respiratory distress syndrome; liquid artificial lung ventilation; perfluorodecalin

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