Background: Ventilatory pressures should target the range between the upper and lower inflection point of the pressure volume curve in order to avoid atelecto- and volutrauma. During high-frequency oscillatory ventilation (HFOV), this range is difficult to determine. Quadrant impedance measurement (QIM) has recently been shown to allow accurate and precise measurement of lung volume changes during conventional mechanical ventilation. Objectives: To investigate if QIM can be used to determine a static pressure-residual impedance curve during a recruitment-derecruitment manoeuvre on HFOV and to monitor the time course of alveolar recruitment after changing mean airway pressure (MAP). Methods: An incremental and decremental MAP trial (6 cm H₂O to 27 cm H₂O) was conducted in five surfactantdepleted newborn piglets during HFOV. Ventilatory, gas exchange and haemodynamic parameters were recorded. Continuous measurement of thoracic impedance change was performed. Results: Mean residual impedance (RI) increased with each stepwise increase of MAP resulting in a total mean increase of +26.5% (±4.0) at the highest MAP (27 cm H₂O) compared to baseline ventilation at 6 cm H₂O. Upon decreasing MAP levels, RI fell more slowly compared to its ascent; 83.4% (±19.1) and 84.8% (±16.4) of impedance changes occurred in the first 5 min after an increase or decrease in airway pressure, respectively. Conclusions: QIM could be used for continuous monitoring of thoracic impedance and determination of the pressure-RI curve during HFOV. The method could prove to be a promising bedside method for the monitoring of lung recruitment during HFOV in the future.

Although liquid ventilation has been researched and studied for the last six decades, it did not achieve its expected optimal performance. Within this work, a deeper understanding of the fluid dynamics during liquid ventilation shall be gathered to extend the already available clinical knowledge about this ventilation strategy. In order to reach this goal, advanced optical flow measurement techniques are applied in different models of the human conductive airways to obtain global velocity fields, identifying prominent flow structures and to determine important dissolved oxygen transport paths. As the velocity measurements revealed, the evolving flow field is strongly dominated by secondary flow effects and is highly dependent on the local airway geometry. During the visualization experiments of the dissolved oxygen concentration fields, different transportation paths occur at inspirational and expirational flow. The initial concentration distribution can be linked to the underlying flow fields but decouples after the peak velocity phases. With higher flow rates/ tidal volumes, a more homogeneously distributed oxygen concentration can be reached.:List of Figures ....................................................................................... VII List of Tables ........................................................................................XIII Nomenclature ........................................................................................ XV 1 Introduction......................................................................................... 1 1.1 Motivation ........................................................................................1 1.2 Research objectives........................................................................... 3 1.3 Outline............................................................................................ 4 2 State of the art .................................................................................... 5 2.1 Liquid Ventilation............................................................................. 5 2.2 In vitro modeling.............................................................................. 8 2.3 Flow measurements ......................................................................... 11 2.4 Gas transport..................................................................................13 3 Flow field measurements ................................................................... 16 3.1 Hydrodynamic Model.......................................................................16 3.1.1 Lung replica ..........................................................................16 3.1.2 Flow parameter .....................................................................18 3.1.3 Limitations ...........................................................................22 3.2 Particle Tracking Velocimetry (PTV) ................................................24 3.2.1 Measurement principle ...........................................................24 3.2.2 Double-frame 2D-PTV ...........................................................25 3.2.3 Time-resolved 3D-PTV ..........................................................28 3.2.4 Phase-locked ensemble PTV ................................................... 31 3.3 Experimental set-up and measurement procedure ...............................33 3.3.1 Lung flow facility...................................................................33 3.3.2 2D-PTV configuration............................................................36 3.3.3 3D-PTV configuration............................................................36 3.4 Results & Discussion........................................................................38 3.4.1 Artificial lung........................................................................38 3.4.2 Realistic lung ........................................................................52 3.5 Conclusion ......................................................................................59 4 Oxygen transport ...............................................................................61 4.1 Hydrodynamic Model....................................................................... 61 4.1.1 Lung replica .......................................................................... 61 4.1.2 Flow parameter .....................................................................62 4.1.3 Limitations ...........................................................................65 4.2 Oxygen Sensitive Dye ......................................................................66 4.3 Experimental set-up......................................................................... 71 4.4 Results & Discussion........................................................................75 4.4.1 Constant flow rate .................................................................75 4.4.2 Oscillatory flow .....................................................................83 4.5 Conclusion ......................................................................................90 5 Summary............................................................................................ 92 6 Outlook .............................................................................................. 95 Bibliography ............................................................................................ 97 / Trotz intensiver Forschung in den letzten sechs Jahrzehnten, befindet sich die Flüssigkeitsbeatmung immernoch weit entfernt vom klinischen Alltag. Mit dieser Arbeit soll ein Beitrag geleistet werden, um das Wissen um die strömungsmechanischen Effekte während der Flüssigkeitsbeatmung zu vertiefen. Dazu werden verschiedene Modellexperimente durchgeführt, bei welchen moderne laseroptische Strömungsmessmethoden zum Einsatz kommen. Untersucht werden dabei unterschiedlich komplexe Geometrien der leitenden menschlichen Atemwege mit dem Ziel wesentliche Strömungsstrukturen, globale Geschwindigkeitsfelder und wichtige Transportwege des gelösten Sauerstoffs zu identifiziern. Die Geschwindigkeitsmessungen zeigen ein stark durch sekundäre Strömungseffekte dominiertes Geschwindigkeitsfeld, welches wesentlich von der lokalen Geometrie abhängig ist. Durch die qualitative und quantitative Erfassung der gelösten Sauerstoffkonzentrationsfelder können wichtige Transportwege aufgedeckt werden. Diese unterscheiden sich deutlich zwischen inspiratorischer und expiratorischer Strömungsrichtung. Die initialen Konzentrationsfelder stimmen mit den unterliegenden Geschwindigkeitsfeldern überein, unterscheiden sich ab der verzögernden Strömungsphase jedoch. Höhere Volumenströme/Tidalvolumen tragen dabei zu einer gleichmäßigeren Konzentrationsverteilung bei.:List of Figures ....................................................................................... VII List of Tables ........................................................................................XIII Nomenclature ........................................................................................ XV 1 Introduction......................................................................................... 1 1.1 Motivation ........................................................................................1 1.2 Research objectives........................................................................... 3 1.3 Outline............................................................................................ 4 2 State of the art .................................................................................... 5 2.1 Liquid Ventilation............................................................................. 5 2.2 In vitro modeling.............................................................................. 8 2.3 Flow measurements ......................................................................... 11 2.4 Gas transport..................................................................................13 3 Flow field measurements ................................................................... 16 3.1 Hydrodynamic Model.......................................................................16 3.1.1 Lung replica ..........................................................................16 3.1.2 Flow parameter .....................................................................18 3.1.3 Limitations ...........................................................................22 3.2 Particle Tracking Velocimetry (PTV) ................................................24 3.2.1 Measurement principle ...........................................................24 3.2.2 Double-frame 2D-PTV ...........................................................25 3.2.3 Time-resolved 3D-PTV ..........................................................28 3.2.4 Phase-locked ensemble PTV ................................................... 31 3.3 Experimental set-up and measurement procedure ...............................33 3.3.1 Lung flow facility...................................................................33 3.3.2 2D-PTV configuration............................................................36 3.3.3 3D-PTV configuration............................................................36 3.4 Results & Discussion........................................................................38 3.4.1 Artificial lung........................................................................38 3.4.2 Realistic lung ........................................................................52 3.5 Conclusion ......................................................................................59 4 Oxygen transport ...............................................................................61 4.1 Hydrodynamic Model....................................................................... 61 4.1.1 Lung replica .......................................................................... 61 4.1.2 Flow parameter .....................................................................62 4.1.3 Limitations ...........................................................................65 4.2 Oxygen Sensitive Dye ......................................................................66 4.3 Experimental set-up......................................................................... 71 4.4 Results & Discussion........................................................................75 4.4.1 Constant flow rate .................................................................75 4.4.2 Oscillatory flow .....................................................................83 4.5 Conclusion ......................................................................................90 5 Summary............................................................................................ 92 6 Outlook .............................................................................................. 95 Bibliography ............................................................................................ 97