A Clinical Study On Effects Of Vaporized Perlfuorocarbon Inhalation On Adult Patients With Acute Lung Injury And Acute Respiratory Distress Syndrome

Objective:Acute lung injury (ALI)/Acute Respiratory Distress Syndrome (ARDS)is a serious and common condition for which there are currently no specific strategiesfor treatment. It has been proved that perfluorocarbon vaporization inhalation hastherapeutic effects on ALI/ARDS in animal models and vitro studies. The study aimedto evaluate the clinical effects, mechanism and safety of perfluorocarbon vaporizationinhalation through randomized controlled trial.Methods:(1)The ALI/ARDS patients who received noninvasive positive pressureventilation (NPPV) were randomly divided into treatment or control group. Patients intreatment group received200ml perfluorocarbon vaporization inhalation every12hoursfor3days successively, patients in control group received sterile water inhalation. Aftertreatment, a comparison was made in oxygenation index, the proportion of patientsrequiring intubation, mortality in ICU within28days and the incidence ofcomplications between the two groups;(2)The ALI/ARDS patients who receivedinvasive positive pressure ventilation (IPPV) were randomly divided into treatment orcontrol group. Patients in treatment group received100ml perfluorocarbon vaporizationinhalation every8hours for5days successively, patients in control group receivedsterile water inhalation. After treatment, a comparison was made in oxygenation index,mortality in ICU within28days, the numbers of ventilator-free days between day1andday28, the incidence of complications between the two groups;(3)The level of whiteblood cell count, TNF-a and IL-1βwere detected before and after the therapy.ThemicroRNAs and genes differently expressed before and after the inhalation of theperfluorocarbon were detected by the application of microRNA and cDNA microarrays.Results(:1)19patients who received NPPV were divided into treatment group and20patients were divided into control group. There was no significant difference inoxygenation index(P>0.05), the proportion of patients requiring intubation(P=0.73),mortality in ICU within28days (P=0.71) and the incidence of complications betweenthe two groups; (2)12patients who received IPPV were divided into treatment group and10patients were divided into control group. There was no significant difference inoxygenation index(P>0.05), the numbers of ventilator-free days between day1and day28(P=0.39),mortality in ICU within28days (P=0.67) between the two groups. But onthe third days, the mean arterial blood pressure in treatment group was higher than thatin the control group(99.57vs.82.44, P=0.02);(3)The level of C-reactive protein of treatment group declined but was notsignificantly different from that of the control group (P>0.05). There was nosignificant difference in the level of white blood cell count, TNF-a and IL-1βbetweenthe two groups. Different expressions were detected in5miRNAs (miR-30C-1-3p,miR-3178, miR-4534, hsa-miR-4725-3p, miR-92b-5p) and255genes before and afterthe inhalation of the perfluorocarbon.Conclusions:(1)The efficacy of perfluorocarbon vaporization inhalation throughNPPV is not different from NPPV and is safe for ALI/ARDS patients;(2)The efficacyof perfluorocarbon vaporization inhalation through IPPV is not different from IPPV forALI/ARDS patients, but it may result in hemodynamic changes;(3)Perfluorocarbonvaporization inhalation may play a biological role by affecting the expression in anumber of miRNAs and genes.