Use of liquid ventilation with perflubron during extracorporeal membrane oxygenation: chest radiographic appearances.

Abstract

A minority of neonates or infants with severe respiratory failure or pulmonary hypertension do not respond adequately to treatment with ECMO and are almost certain to die with termination of ECMO support. Liquid ventilation with perflubron offers a potential salvage therapy in this patient population. In addition, perflubron is a good contrast agent to use in the evaluation of neonatal pulmonary abnormalities.

Effect of single versus multiple dosing on perfluorochemical distribution and elimination during partial liquid ventilation

“…Abnormal lung mechanics may impact both distribution of gas and PFC liquid; 28 therefore, it is reasonable to speculate that the effect of dosing on the time-dependent PFC liquid distribution and elimination profile may be markedly different in the abnormal lung as compared to the normal lung desrcibed herein. On this basis, subsequent study is warranted to evaluate the potential physiological benefit of dosing schedules in lungs with elastic and obstructive pathology.…”

Liquid-assisted ventilation: An alternative respiratory modality

“…59 Regional differences in PFC clearing, detected on x-ray, were related to localized bronchial obstruction. 52 Over the course of the study, LiquiVent serum levels did not exceed 8 g/gm blood. 161 Four infants were successfully weaned off of ECLS for at least 3 days, and two infants (both with ARDS) are long-term survivors after PLV.…”

“…1 59 ) (see Clinical Studies) have proven informative to delineate the degree of pulmonary hypoplasia, as well as the relationship between PFC physicochemical properties, distribution, and elimination pattern of the PFC liquid. 29,52,54,55,[60][61][62] Conventionally, the ability to evaluate small airway pathology with bronchographic agents has been limited by poor resolution of the bronchioles at the secondary lobule level. 63 Because of its density, low surface tension, and intense radiopacity, perflubron has been used as a bronchographic contrast agent for HRCT.…”

“…52,59,161 This was an open-labeled nonrandomized or blinded, multicenter study. All infants demonstrated lung recruitment and improved lung compliance; mean PFC loss rate was 0.63 ± 0.2 SE mL/kg/hr during the first few hours post-instillation.…”

Partial Liquid Ventilation in Critically Ill Infants Receiving Extracorporeal Life Support

“…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.…”