Partial Liquid Ventilation in Adult Patients with Acute Respiratory Distress Syndrome

• Published in: American journal of respiratory and critical care medicine Vol. 173; no. 8; pp. 882 - 889
• Main Authors: Kacmarek, Robert M, Wiedemann, Herbert P, Lavin, Philip T, Wedel, Mark K, Tutuncu, Ahmet S, Slutsky, Arthur S
• Format: Journal Article
• Language: English
• Published: New York, NY Am Thoracic Soc 15.04.2006; American Lung Association; American Thoracic Society
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Catheters; Clinical death. Palliative care. Organ gift and preservation; Clinical trials; Dose-Response Relationship, Drug; Emergency and intensive respiratory care; Female; Fluorocarbons - administration & dosage; Fluorocarbons - therapeutic use; Follow-Up Studies; Gases; Humans; Instillation, Drug; Intensive care medicine; Liquid Ventilation - methods; Lungs; Male; Medical sciences; Middle Aged; Mortality; Perfluorocarbons; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - mortality; Respiratory Distress Syndrome, Adult - therapy; Retrospective Studies; Suctioning; Survival Rate; Treatment Outcome; Ventilation; Ventilators; Human; Intensive care; Liquid ventilation; Respiratory disease; acute respiratory distress syndrome; Respiratory distress; Mechanical ventilation; partial liquid ventilation; Resuscitation
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200508-1196OC

Despite recent clinical trials demonstrating improved outcome in acute respiratory distress syndrome (ARDS), mortality remains high. Partial liquid ventilation (PLV) using perfluorocarbons has been shown to improve oxygenation and decrease lung injury in various animal models. To determine if PLV would have an impact on outcome in patients with ARDS. Patients with ARDS were randomized to (1) conventional mechanical ventilation (CMV; n=107), (2) "low-dose" perfluorocarbon (10 ml/kg; n=99), and (3) "high-dose" perfluorocarbon (20 ml/kg; n=105). Patients in all three groups were ventilated using volume ventilation, Vt <or= 10 ml/kg predicted body weight, rate <or= 25/min, inspiratory-to-expiratory ratio <or= 1:1, Fi(O(2)) >or= 0.5, and positive end-expiratory pressure >or= 13 cm H(2)O. The 28-d mortality in the CMV group was 15%, versus 26.3% in the low-dose (p=0.06) and 19.1% in the high-dose (p=0.39) PLV groups. There were more ventilator-free days in the CMV group (13.0+/-9.3) compared with both the low-dose (7.4+/-8.5; p<0.001) and high-dose (9.9+/-9.1; p=0.043) groups. There were more pneumothoraces, hypoxic episodes, and hypotensive episodes in the PLV patients. PLV at both high and low doses did not improve outcome in ARDS compared with CMV and cannot be recommended for patients with ARDS.