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Partial liquid ventilation in critically ill infants receiving extracorporeal life support. Philadelphia Liquid
J S Greenspan1, W W Fox, S D Rubenstein
1Department of Pediatrics, Jefferson Medical College, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Insights
Partial liquid ventilation (PLV) with perflubron safely improved lung function and volume in critically ill infants on extracorporeal life support (ECLS). This therapy shows promise for infants with acute respiratory distress syndrome (ARDS).
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Critically ill infants on extracorporeal life support (ECLS) often have poor prognoses.
- Acute respiratory distress syndrome (ARDS) and congenital diaphragmatic hernia (CDH) are severe conditions requiring advanced respiratory support.
- Limited treatment options exist for infants failing to improve with ECLS.
Purpose of the Study:
- To evaluate the safety and efficacy of partial liquid ventilation (PLV) using perflubron in infants receiving ECLS.
- To assess improvements in pulmonary function and lung recruitment.
- To determine if PLV can reduce mortality in this high-risk population.
Main Methods:
- An open-label, noncontrolled, phase I/II trial was conducted.
- Six infants (2 with CDH, 4 with ARDS) failing ECLS received PLV with perflubron for 4-96 hours.
- Functional residual capacity was maintained with sterile perflubron.
Main Results:
- Four infants were successfully weaned from ECLS for at least 3 days.
- Two infants with ARDS achieved long-term survival post-PLV.
- All infants showed lung recruitment and improved lung compliance with no PLV-related adverse events.
Conclusions:
- Perflubron PLV is safe and effective in improving lung function and recruiting lung volume in critically ill infants on ECLS.
- PLV demonstrates significant promise for infants with ARDS.
- Findings support further investigation of PLV in select infants, including those pre-ECLS.
Objectives:
To demonstrate that a period of partial liquid ventilation (PLV) with perflubron improves pulmonary function, without adverse events, in a select group of critically ill infants receiving extracorporeal life support (ECLS) with a high likelihood of mortality.
Methods:
This was an open-label, noncontrolled, phase I and II trial of PLV in two infants with congenital diaphragmatic hernia and four infants with acute respiratory distress syndrome (ARDS) who were failing to improve while receiving ECLS. PLV was performed by instilling and maintaining a functional residual capacity of sterile perflubron for 4 to 96 hours.
Results:
Four infants were successfully weaned off ECLS for at least 3 days, and two infants (both with ARDS) are long-term survivors after PLV. All infants demonstrated lung recruitment and improved lung compliance, and there were no adverse events related to PLV.
Conclusions:
The study suggests that perflubron PLV is safe, improves lung function, and recruits lung volume in critically ill infants receiving ECLS. PLV therapy for infants with ARDS seems to have a great deal of promise. Based on this and other phase I and II trials, studies of PLV on selected full-term infants before ECLS have been initiated.