Substantiation of the possibility of using bronchoalveolar lavage with perfluorocarbon
fluids for the treatment of the alveolar stage of toxic pulmonary edema
Authors: Isabekov Nikolaj Rinatovich , Tonshin Anton A. , Bonitenko Evgenij Yu. 
Published: March 2024

Introduction. Toxic pulmonary edema is an acute syndrome characterized by the
accumulation of fluid in the extravascular spaces of the lungs, impaired gas exchange, the
formation of tissue hypoxia and acidosis, which can occur in acute inhalation poisoning with
pulmonary toxicants at work. Existing methods of drug and respiratory therapy are ineffective
in the development of alveolar pulmonary edema (end-stage acute respiratory distress syndrome;
ARDS). In this regard, the search for new approaches to the treatment of this condition, which
is characterized by almost 100 % mortality, is of great practical importance. One of such
approaches is the use of perfluorocarbon (PFC) fluids, which, due to their unique physical and
chemical properties, are able not only to ensure the evacuation of edematous fluid from the
alveoli and respiratory tract, but also to restore gas exchange in the parts of the lungs
filled with them. This article will present an experimental evaluation of the use of PFC
fluids in a model of the alveolar stage of toxic pulmonary edema. The goal of the study
is to determine the effect of bronchoalveolar lavage (BAL) using perfluorocarbons on the
indicators of acute respiratory failure and the outcome of the alveolar stage of toxic
pulmonary edema. Materials and methods. The study was carried out on male Wistar rats
aged 4 months, weighing 180–230 g. Toxic pulmonary edema was initiated by endotracheal
injection of 0.1 M HCl solution. Anesthetized rats were intubated with a cannula, then
intratracheally injected with 0.1 M HCl solution at a dose of 2 ml/kg and connected to a
ventilator. After that, the animals were randomized by weight into groups of 6 individuals
each. Animals of the experimental group with a decrease in saturation below 80%, 2–6
procedures of bronchoalveolar lavage (BAL) with PFC-oxygenated liquid in a single dose of 2.0
ml/kg were performed. Heart rate, oxygen saturation, duration of survival, and overall
survival by group were recorded. The resalts. In all rats, there was a decrease in oxygen
saturation (SpO2) and heart rate (HR) after HCl administration, which was restored to the
lower limits of normal within 5 minutes. However, after 25 to 30 minutes, the animals
experienced a rapid decrease in SpO2, an increase in heart rate, the appearance of wet
wheezing in the lungs, and the discharge of foamy fluid from the catheter. Against this
background, there was a rapid death of animals, At the same time, the average duration of
survival was 30.6±3.3 min. In turn, in the animals of the experimental group, after each BAL
procedure, an increase in saturation was noted, it was possible to evacuate a total of 9.1±0.8
ml/kg of edematous fluid from the lungs. It was also noted that the average duration of
survival of rats in the experimental group was 1.69 times and amounted to 51.6±3.8
minutes. Conclusions. The use of BAL with PFC fluids in the alveolar stage of toxic
pulmonary edema makes it possible to evacuate a significant amount of edematous fluid from the
lower parts of the lungs due to its displacement by a perfluorocarbon with a higher density;
to short-term reduce the severity of manifestations of acute respiratory failure after
instillation of oxygenated PFC liquid; to increase the duration of survival of animals by
ensuring gas exchange in previously uninvolved parts of the lungs. Ethics. The study was
conducted in accordance with the ethical principles of the Declaration of Helsinki. The
Clinical Study Protocol was reviewed at a meeting of the local Ethics Committee FSBSI IRIOH.
Protocol No. 4 of May 25, 2022.