Bronchoscopic Lavage with Perfluorocarbon Decreases Postprocedure Hypoxemia in an Ovine Model of Smoke Inhalation

Abstract

Bronchoscopy and lavage are used to confirm diagnosis and can be therapeutic in patients suffering inhalation injury. Lavage is traditionally performed using saline, which is unfortunately associated with profound transient hypoxemia. Perfluorocarbons, having a high gas solubility for oxygen and carbon dioxide, increase oxygenation when instilled into the airway. We hypothesized that the use of perfluorocarbons for bronchoscopic lavage would attenuate this transient hypoxemia. Sheep were prepared for chronic study. They were insufflated with cotton smoke and then randomized to receive a lavage with 200 mL of perfluorocarbon or saline at 2, 6, 12, and 24 hours after injury. All animals had a steady and significant decline in their pre- to post-PaO2/FiO2 (P/F) ratio. At 2, 6, and 12 hours, the saline lavage group had a significant decrease in their P/F ratio (485+/-32 to 212+/-37 mm Hg, 439+/-22 to 170+/-40 mm Hg, and 381+/-48 to 184+/-59 mm Hg). This decrease in P/F ratio was not observed in the perfluorocarbon group (474+/-19 to 459+/-29 mm Hg, 424+/-32 to 387+/-43 mm Hg, and 366+/-50 to 357+/-67 mm Hg). These findings indicate that perfluorocarbons attenuate the transient hypoxemia associated with saline bronchoscopic lavage and thus may be considered safer for patients with acute lung injury.