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Initial experience with partial liquid ventilation in adult patients with the acute respiratory distress syndrome
R B Hirschl1, T Pranikoff, C Wise
1Department 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.