Initial experience with partial liquid ventilation in adult patients with the acute respiratory distress syndrome

R. B. Hirschl, T. Pranikoff, C. Wise, M. C. Overbeck, P. Gauger, R. J. Schreiner, R. Dechert and R. H. Bartlett
Department of Surgery, University of Michigan, Ann Arbor, USA.

OBJECTIVE--To evaluate the safety and efficacy of partial liquid ventilation (PLV). DESIGN--Before-after trial. SETTING--The surgical intensive care unit at the University of Michigan, Ann Arbor, from April to December 1994. PATIENTS--A consecutive sample of 10 patients aged 19 to 55 years with the acute respiratory distress syndrome who were receiving extracorporeal life support. INTERVENTION--Perflubron was administered into the trachea until the dependent zone of the lung was filled. Gas ventilation of the perflubron-filled lung was then performed (PLV). Volatilized perflubron replacement was repeated daily for from 1 to 7 days with a median cumulative dose of 38 mL/kg (range, 15 to 62 mL/kg). MAIN OUTCOME MEASURES--Physiologic shunt and static pulmonary compliance. RESULTS--Physiologic shunt decreased from a median of 0.72 (range, 0.37 to 1.0) to 0.46 (range, 0.21 to 0.96) over the 72 hours following initiation of PLV (P = .01 by repeated measures analysis of variance). Static pulmonary compliance corrected for patient weight increased from a median of 0.16 mL/cm H2O per kilogram (range, 0.01 to 0.48 mL/cm H2O per kilogram) to 0.27 mL/cm H2O per kilogram (range, 0.05 to 1.11 mL/cm H2O per kilogram) over the same time period (P = .04 by repeated measures analysis of variance). Overall survival was five (50%) of 10 patients. Complications that were potentially associated with PLV included pneumothorax development in one patient and mucus plug formation in one patient. CONCLUSIONS--Perflubron may be safely administered into the lungs of patients with severe respiratory failure receiving extracorporeal life support and may be associated with improvement in gas exchange and pulmonary compliance.

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