Liquid ventilation of human preterm neonates

Greenspan, Jay S.; Wolfson, Marla R.; Rubenstein, S. David; Shaffer, Thomas H.

doi:10.1016/s0022-3476(05)82457-6

Cited by 240 publications

(94 citation statements)

References 9 publications

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“…A few studies reported hemodynamic compromise during total liquid ventilation. The authors of these studies attributed this result to the filling of the lung with high-density PFCs [2,3]. The observed hemodynamic compromise in these total liquid ventilation studies is speculated to result from pulmonary vascular compression, which is caused by an increase in the alveolar hydrostatic pressure gradient [9], and/or through an impairment of CO via a decrease in right ventricular preload combined with an increase in right ventricular afterload [10].…”

Section: Discussionmentioning

confidence: 99%

“…Since then PFCs have been investigated extensively as an alternative means of respiratory support, and PFCs oxygenated outside the body have been used in the treatment of acute respiratory failure [2,3]. In 1991 Fuhrman et al [4] demonstrated the feasibility of applying liquid ventilation in healthy animals without the need for a specialized liquid breathing system.…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic effects of partial liquid ventilation with perfluorocarbon in acute lung injury

Houmes¹,

Verbrugge²,

Hendrik³

et al. 1995

Intensive Care Med

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Objective: To assess the effect of partial liquid ventilation with perfluorocarbons on hemodynamics and gas exchange in large pigs with induced acute lung injury (ALI). Design: Randomized, prospective, double-control, experimental study. Setting: Experimental intensive care unit of a university. Materials: Eighteen large pigs (50 _+ 5 kg body weight) with an average anterior posterior thoracic diameter of 24 cm and induced acute lung injury. Interventions: All animals were surfactant depleted by lung lavage to a PaO2 below 100 mmHg and randomized to receive either perflubron (n = 6) or saline (n = 6) in five intratracheal doses of 5 ml/kg at 20-rain intervals, or no instillation (n = 6). Measurements and results:In all animals heart rate, arterial pressures, pulmonary pressures, cardiac output and blood gases were recorded at 20-rain intervals. There was no deleterious effect on any hemodynamic parameter in the perflubron group, whereas systolic and mean pulmonary arterial pressure values showed a persistent decrease after the first 5 ml/kg of perflubron, from 48.7 _+ 14.1 to 40.8 _+ 11.7 mmHg and from 39.7 _+ 13.2 to 35.2 _+ 12.0 mmHg, respectively. Perflubron resulted in a significant (ANOVA P < 0.01), dose-dependent increase in PaO2 values from 86.3 _+ 22.4 to a maximum of 342.4 _+ 59.4 mmHg at a dose of 25 ml/kg; the other groups showed no significant increase in P.O2. Conclusions: Tracheal instillation of perflubron in induced ALI results in a dose-dependent increase in PaO2 and has no deleterious effect on hemodynamic parameters.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hemodynamic effects of partial liquid ventilation with perfluorocarbon in acute lung injury

Houmes¹,

Verbrugge²,

Hendrik³

et al. 1995

Intensive Care Med

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“…The improvement in pulmonary compliance with PLV observed in the present study was more gradual when compared with experience in animals and preterm infants with respiratory distress syndrome. 2,5 In the preterm population, the predominant mechanism of action of perflubron PLV is the reduction of surface tension and volume recruitment of collapsed terminal air spaces. In the larger infant with ARDS, the mechanism of action of perflubron PLV is predominantly through volume recruitment of alveoli that have been filled with debris.…”

Section: Discussionmentioning

confidence: 99%

Partial Liquid Ventilation in Critically Ill Infants Receiving Extracorporeal Life Support

et al. 1997

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ABSTRACT. 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. Pediatrics 1997;99(1). URL: http://www. pediatrics.org/cgi/content/full/99/1/e2; congenital diaphragmatic hernia, acute respiratory distress syndrome, partial liquid ventilation, extracorporeal life support.ABBREVIATIONS. ECLS, extracorporeal life support; ARDS, acute respiratory distress syndrome; CDH, congenital diaphragmatic hernia; PLV, partial liquid ventilation; FRC, functional residual capacity.Perfluorochemicals have been explored as respiratory media for more than 20 years in many animal models of respiratory disease and, more recently, in initial phase I and II human trials of liquid ventilation.1-7 These chemicals are very stable, have low surface tension, are generally insoluble in water or lipid, and are excellent solvents for respiratory gases. The effectiveness of liquid ventilation is achieved, in part, through recruitment of collapsed gas-exchanging units, increasing lung compliance, and cleansing the lung of pulmonary debris. Sterile perflubron (LiquiVent; Alliance Pharmaceutical Corp, San Diego, CA), is one of very few perfluorochemicals that is produced as a medical-grade drug. The compound has an impressive biocompatibility profile in animals and humans and is the only fluid that is approved by the Federal Food and Drug Administration for testing as a breathing agent. Perflubron has a high solubility for respiratory gases, a positive spreading coefficient on saline, and a low viscosity and is highly radiopaque on plain radiograph or computed tomographic imaging. 8,9 Recent advances in respiratory therapies for the critically ill neonates have expanded the treatment options for infants with severe respiratory failure. In those severely effected infants, extracorporeal life support (ECLS) may result in increased survival. Nevertheless, morbidity remains high, ...

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“…No ano seguinte, os mesmos autores (86) relataram mais três casos de ventilação com perfluorocarbono, em condições semelhantes às do relato inicial. Os resultados foram semelhantes, confirmando o PFC como um método alternativo de ventilação para os pulmões de neonatos.…”

Section: J Pneumol 28(6) -Nov-dez De 2002unclassified

Ventilação líquida: revisão da literatura

2002

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Atualmente, novas alternativas de ventilação têm sido estudadas em quadros de insuficiência respiratória, com o objetivo de melhorar a oxigenação e minimizar a agressão ao parênquima pulmonar. A utilização de perfluorocarbonos líquidos administrados diretamente na via aérea vem sendo ostensivamente estudada em modelos de lesão pulmonar e em alguns ensaios clínicos, demonstrando bons resultados com relação à troca gasosa, mecânica ventilatória e propriedades antiinflamatórias. Os PFCs são substâncias que possuem baixa tensão superficial, alta densidade, são insolúveis em água, além de permitirem alta difusão de oxigênio e gás carbônico. Esses compostos atuam recrutando alvéolos colapsados, melhorando a oxigenação, protegendo a arquitetura pulmonar e atuando como carreadores de impurezas, limpando a superfície alveolar de resíduos da degradação celular. Neste artigo de revisão são apresentadas as diferentes modalidades ventilatórias com perfluorocarbonos e fornecidas informações sobre a utilização e o estado atual da ventilação líquida. (J Pneumol 2002;28(6):351-61)

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Liquid ventilation of human preterm neonates

Cited by 240 publications

References 9 publications

Hemodynamic effects of partial liquid ventilation with perfluorocarbon in acute lung injury

Hemodynamic effects of partial liquid ventilation with perfluorocarbon in acute lung injury

Partial Liquid Ventilation in Critically Ill Infants Receiving Extracorporeal Life Support

Ventilação líquida: revisão da literatura

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