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. 1998 Nov;228(5):692–700. doi: 10.1097/00000658-199811000-00009

Partial liquid ventilation in adult patients with ARDS: a multicenter phase I-II trial. Adult PLV Study Group.

R B Hirschl 1, S Conrad 1, R Kaiser 1, J B Zwischenberger 1, R H Bartlett 1, F Booth 1, V Cardenas 1
PMCID: PMC1191575  PMID: 9833808

Abstract

OBJECTIVE: To evaluate the safety and efficacy of partial liquid ventilation (PLV) in adult patients with the acute respiratory distress syndrome (ARDS). SUMMARY BACKGROUND DATA: Previous studies have evaluated gas exchange and the safety of PLV in adult patients with severe respiratory failure whose gas exchange was partially provided by extracorporeal life support (ECLS). This is the first experience with adult patients who were not on ECLS. METHODS: Intratracheal perflubron in a total dose of 30.1 +/- 7.1 ml/kg was administered over a period of 45 +/- 9 hours to nine adult patients with mean age = 49 +/- 4 years and mean PaO2/FiO2 ratio = 128 +/- 7 as part of a prospective, multicenter, phase I-II noncontrolled trial. RESULTS: Significant decreases in mean (A-a)DO2 (baseline = 430 +/- 47, 48 hour = 229 +/- 17, p = 0.0127 by ANOVA) and FiO2 (baseline = 0.82 +/- 0.08, 48 hour = 0.54 +/- 0.06, p = 0.025), along with an increase in mean SvO2 (baseline = 75 +/- 3, 48 hour = 85 +/- 2, p = 0.018 by ANOVA) were observed. No significant changes in pulmonary compliance or hemodynamic variables were noted. Seven of the nine patients in this study survived beyond 28 days after initiation of partial liquid ventilation whereas 5 patients survived to discharge. Three adverse events [hypoxia (2) and hyperbilirubinemia (1)] were determined to be severe in nature. CONCLUSIONS: These data suggest that PLV may be performed safely with few related severe adverse effects. Improvement in gas exchange was observed in this series of adult patients over the 48 hours after initiation of PLV.

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Selected References

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  1. Bernard G. R., Artigas A., Brigham K. L., Carlet J., Falke K., Hudson L., Lamy M., Legall J. R., Morris A., Spragg R. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med. 1994 Mar;149(3 Pt 1):818–824. doi: 10.1164/ajrccm.149.3.7509706. [DOI] [PubMed] [Google Scholar]
  2. Curtis S. E., Fuhrman B. P., Howland D. F. Airway and alveolar pressures during perfluorocarbon breathing in infant lambs. J Appl Physiol (1985) 1990 Jun;68(6):2322–2328. doi: 10.1152/jappl.1990.68.6.2322. [DOI] [PubMed] [Google Scholar]
  3. Curtis S. E., Peek J. T., Kelly D. R. Partial liquid breathing with perflubron improves arterial oxygenation in acute canine lung injury. J Appl Physiol (1985) 1993 Dec;75(6):2696–2702. doi: 10.1152/jappl.1993.75.6.2696. [DOI] [PubMed] [Google Scholar]
  4. Fuhrman B. P., Paczan P. R., DeFrancisis M. Perfluorocarbon-associated gas exchange. Crit Care Med. 1991 May;19(5):712–722. doi: 10.1097/00003246-199105000-00019. [DOI] [PubMed] [Google Scholar]
  5. Gattinoni L., Bombino M., Pelosi P., Lissoni A., Pesenti A., Fumagalli R., Tagliabue M. Lung structure and function in different stages of severe adult respiratory distress syndrome. JAMA. 1994 Jun 8;271(22):1772–1779. [PubMed] [Google Scholar]
  6. Gattinoni L., D'Andrea L., Pelosi P., Vitale G., Pesenti A., Fumagalli R. Regional effects and mechanism of positive end-expiratory pressure in early adult respiratory distress syndrome. JAMA. 1993 Apr 28;269(16):2122–2127. [PubMed] [Google Scholar]
  7. Gauger P. G., Overbeck M. C., Koeppe R. A., Shulkin B. L., Hrycko J. N., Weber E. D., Hirschl R. B. Distribution of pulmonary blood flow and total lung water during partial liquid ventilation in acute lung injury. Surgery. 1997 Aug;122(2):313–323. doi: 10.1016/s0039-6060(97)90023-4. [DOI] [PubMed] [Google Scholar]
  8. Gauger P. G., Pranikoff T., Schreiner R. J., Moler F. W., Hirschl R. B. Initial experience with partial liquid ventilation in pediatric patients with the acute respiratory distress syndrome. Crit Care Med. 1996 Jan;24(1):16–22. doi: 10.1097/00003246-199601000-00006. [DOI] [PubMed] [Google Scholar]
  9. Greenspan J. S., Wolfson M. R., Rubenstein S. D., Shaffer T. H. Liquid ventilation of human preterm neonates. J Pediatr. 1990 Jul;117(1 Pt 1):106–111. doi: 10.1016/s0022-3476(05)82457-6. [DOI] [PubMed] [Google Scholar]
  10. Hirschl R. B., Overbeck M. C., Parent A., Hernandez R., Schwartz S., Dosanjh A., Johnson K., Bartlett R. H. Liquid ventilation provides uniform distribution of perfluorocarbon in the setting of respiratory failure. Surgery. 1994 Aug;116(2):159–168. [PubMed] [Google Scholar]
  11. Hirschl R. B., Pranikoff T., Gauger P., Schreiner R. J., Dechert R., Bartlett R. H. Liquid ventilation in adults, children, and full-term neonates. Lancet. 1995 Nov 4;346(8984):1201–1202. doi: 10.1016/s0140-6736(95)92903-7. [DOI] [PubMed] [Google Scholar]
  12. Hirschl R. B., Pranikoff T., Wise C., Overbeck M. C., Gauger P., Schreiner R. J., Dechert R., Bartlett R. H. Initial experience with partial liquid ventilation in adult patients with the acute respiratory distress syndrome. JAMA. 1996 Feb 7;275(5):383–389. [PubMed] [Google Scholar]
  13. Hirschl R. B., Tooley R., Parent A. C., Johnson K., Bartlett R. H. Improvement of gas exchange, pulmonary function, and lung injury with partial liquid ventilation. A study model in a setting of severe respiratory failure. Chest. 1995 Aug;108(2):500–508. doi: 10.1378/chest.108.2.500. [DOI] [PubMed] [Google Scholar]
  14. Leach C. L., Fuhrman B. P., Morin F. C., 3rd, Rath M. G. Perfluorocarbon-associated gas exchange (partial liquid ventilation) in respiratory distress syndrome: a prospective, randomized, controlled study. Crit Care Med. 1993 Sep;21(9):1270–1278. doi: 10.1097/00003246-199309000-00008. [DOI] [PubMed] [Google Scholar]
  15. Leach C. L., Greenspan J. S., Rubenstein S. D., Shaffer T. H., Wolfson M. R., Jackson J. C., DeLemos R., Fuhrman B. P. Partial liquid ventilation with perflubron in premature infants with severe respiratory distress syndrome. The LiquiVent Study Group. N Engl J Med. 1996 Sep 12;335(11):761–767. doi: 10.1056/NEJM199609123351101. [DOI] [PubMed] [Google Scholar]
  16. Nesti F. D., Fuhrman B. P., Steinhorn D. M., Papo M. C., Hernan L. J., Duffy L. C., Fisher J. E., Leach C. L., Paczan P. R., Burak B. A. Perfluorocarbon-associated gas exchange in gastric aspiration. Crit Care Med. 1994 Sep;22(9):1445–1452. doi: 10.1097/00003246-199409000-00015. [DOI] [PubMed] [Google Scholar]
  17. Overbeck M. C., Pranikoff T., Yadao C. M., Hirschl R. B. Efficacy of perfluorocarbon partial liquid ventilation in a large animal model of acute respiratory failure. Crit Care Med. 1996 Jul;24(7):1208–1214. doi: 10.1097/00003246-199607000-00024. [DOI] [PubMed] [Google Scholar]
  18. Pranikoff T., Gauger P. G., Hirschl R. B. Partial liquid ventilation in newborn patients with congenital diaphragmatic hernia. J Pediatr Surg. 1996 May;31(5):613–618. doi: 10.1016/s0022-3468(96)90659-4. [DOI] [PubMed] [Google Scholar]
  19. Richman P. S., Wolfson M. R., Shaffer T. H. Lung lavage with oxygenated perfluorochemical liquid in acute lung injury. Crit Care Med. 1993 May;21(5):768–774. doi: 10.1097/00003246-199305000-00022. [DOI] [PubMed] [Google Scholar]
  20. Shaffer T. H., Wolfson M. R., Clark L. C., Jr Liquid ventilation. Pediatr Pulmonol. 1992 Oct;14(2):102–109. doi: 10.1002/ppul.1950140208. [DOI] [PubMed] [Google Scholar]
  21. Tooley R., Hirschl R. B., Parent A., Bartlett R. H. Total liquid ventilation with perfluorocarbons increases pulmonary end-expiratory volume and compliance in the setting of lung atelectasis. Crit Care Med. 1996 Feb;24(2):268–273. doi: 10.1097/00003246-199602000-00015. [DOI] [PubMed] [Google Scholar]
  22. Tütüncü A. S., Faithfull N. S., Lachmann B. Comparison of ventilatory support with intratracheal perfluorocarbon administration and conventional mechanical ventilation in animals with acute respiratory failure. Am Rev Respir Dis. 1993 Sep;148(3):785–792. doi: 10.1164/ajrccm/148.3.785. [DOI] [PubMed] [Google Scholar]
  23. Tütüncü A. S., Faithfull N. S., Lachmann B. Intratracheal perfluorocarbon administration combined with mechanical ventilation in experimental respiratory distress syndrome: dose-dependent improvement of gas exchange. Crit Care Med. 1993 Jul;21(7):962–969. doi: 10.1097/00003246-199307000-00008. [DOI] [PubMed] [Google Scholar]
  24. Wilcox D. T., Glick P. L., Karamanoukian H. L., Leach C., Morin F. C., 3rd, Fuhrman B. P. Perfluorocarbon-associated gas exchange improves pulmonary mechanics, oxygenation, ventilation, and allows nitric oxide delivery in the hypoplastic lung congenital diaphragmatic hernia lamb model. Crit Care Med. 1995 Nov;23(11):1858–1863. doi: 10.1097/00003246-199511000-00012. [DOI] [PubMed] [Google Scholar]

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