Manifestations of toxic pulmonary edema during respiratory support in an experiment

Abstract

BACKGROUND: Currently, respiratory support is successfully used to treat pulmonary edema of non-toxic origin. The manifestations of pulmonary edema of non-toxic origin and toxic pulmonary edema have similar features, so respiratory support can be effective in treating the latter.

AIM: To describe the manifestations of toxic pulmonary edema in rabbits and demonstrate the effectiveness of artificial pulmonary ventilation with support of positive end-expiratory pressure (PEEP) in case of severe intoxication with thermal destruction products of fluoroplastic-4.

MATERIALS AND METHODS: Three rabbits were used in the study: rabbit N 1 (control), rabbit N 2 (intoxication) and rabbit N 3 (treatment). Rabbits N 2 and 3 were subjected to severe intoxication with thermal destruction products of fluoroplastic-4 (1,5 HLC50, 15 min). For treatment, rabbit N 3 (treatment), an hour after exposure, underwent mechanical ventilation with PEEP (pressure-controlled mode; oxygen fraction — 0,3; starting PEEP — 5 cm H₂O, tidal volume — 20–25 ml). At various times, chest radiography was performed, oxygenation index, hemoglobin saturation (SaO₂), and partial pressure of carbon dioxide in exhaled air (PetCO₂) were determined. Posthumously, pathological changes in lung tissue, pulmonary coefficient were determined, and histological examination was performed.

RESULTS: Exposure of rabbit N 2 (intoxication) to the thermal destruction products of fluoroplastic-4 led to the sequential formation of the interstitial and alveolar phases of toxic pulmonary edema, which contributed to its death 13 hours after exposure. As SaO₂ decreased and PetCO₂ increased (3 and 5 hours after exposure), in rabbit N 3 (treatment), during respiratory support, PEEP was increased twice by 2 cm H₂O (maintaining a given respiratory volume), which led to the normalization of the studied parameters. On the 7^th day after exposure, the condition of rabbit N 3 (treatment) did not differ from the condition of rabbit N 1 (control); no pathological changes in the respiratory system were detected.

CONCLUSION: Carrying out mechanical ventilation with PEEP, started an hour after exposure (with a stepwise increase in PEEP as the condition worsens), is effective for correcting toxic pulmonary edema in rabbits caused by severe intoxication with the thermal destruction products of fluoroplastic-4.

Keywords

intoxication / toxic pulmonary edema / thermal destruction products / respiratory support / artificial ventilation / positive end expiratory pressure

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