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Byline: Peter N. Cox (1), Helena Frndova (1), Ove Karlsson (1), Stephanie Holowka (2), Charles A. Bryan (1) Keywords: Lung recruitment; Surface tension; Fluorocarbon; Lung volume Abstract: Objective 'Open the lung and keep it open' is increasingly accepted as a fundamental principle for mechanical ventilation. However, it is sometimes very difficult, or impossible, to recruit the diseased lung. We questioned whether one could facilitate recruitment by using a low dose of fluorocarbon in a model previously shown to be non-recruitable by conventional sustained inflation maneuvers. Design and setting Experimental prospective study in a university laboratory. Animals and interventions Nine saline-lavaged rabbits subjected to prolonged large tidal volume mechanical ventilation to establish significant lung injury were randomly allocated to two groups: control [High Frequency Oscillation (HFO) alone: n=4] or 1 ml/kg fluorocarbon (FC) treated (HFO/FC: n=5) for 2+1 h (experiment 1). An additional four similarly prepared animals were treated by single-lung instillation of 0.5 ml/kg dose of fluorocarbon and underwent serial computerized tomography scans at a series of predetermined step-wise pressure increase in both lungs (experiment 2). Measurements and results In experiment 1 there was a very significant improvement in oxygenation in HFO/FC group (PaO.sub.2 increased from 108 mmHg to 424+-81 mmHg P Conclusions We propose that the low equilibrium surface tension and positive spreading coefficient of fluorocarbon facilitates lung recruitment by ungluing adherent surfaces in this model of lung injury. Author Affiliation: (1) Departments of Critical Care Medicine and Lung Biology, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario , M5G 1X8, Canada (2) Department of Radiology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada Article History: Received Date: 14/03/2003 Accepted Date: 04/06/2003 Online Date: 13/09/2003 Article note: Electronic Supplementary Material Supplementary material is available in the online version of this article at http://dx.doi.org/10.1007/s00134-003-1881-1