Pg. Gauger et al., INITIAL EXPERIENCE WITH PARTIAL LIQUID VENTILATION IN PEDIATRIC-PATIENTS WITH THE ACUTE RESPIRATORY-DISTRESS SYNDROME, Critical care medicine, 24(1), 1996, pp. 16-22
Objective: Liquid ventilation with perfluorocarbon previously has not
been reported in pediatric patients with respiratory failure beyond th
e neonatal period. We evaluated the technique of partial liquid ventil
ation in six pediatric patients with the acute respiratory distress sy
ndrome of sufficient severity to require extracorporeal life support (
ECLS). Design: This study was a noncontrolled, phase I/II experimental
study with a single group pretest/posttest design. Setting: All studi
es were performed at a tertiary, pediatric referral hospital at the Un
iversity of Michigan Medical School. Patients: Six pediatric patients,
from 8 wks to 5 1/2 yrs of age, with severe respiratory failure requi
ring ECLS to support gas exchange. Interventions: After 2 to 9 days on
ECLS, perfluorocarbon was administered into the trachea until the dep
endent zone of each lung was filled. The initial dose administered was
12.9 +/- 2.3 mL/kg (range 5 to 20). Gas ventilation of the perfluoroc
arbon filled lungs (partial liquid ventilation) was then performed. Th
e perfluorocarbon dose was repeated daily for a total of 3 to 7 days,
with a cumulative dose of 45.2 +/- 6.1 mL/kg (range 30 to 72.5). Measu
rements and Main Results: All measurements of native gas exchange were
made during brief periods of discontinuation of ECLS and include PaO2
and the alveolar-arterial oxygen gradient, P(A-a)O-2. Static pulmonar
y compliance, corrected for weight, was also measured directly. The me
an PaO2 increased from 39 +/- 6 to 92 +/- 29 torr (5.2 +/- 0.8 to 12.2
+/- 3.9 kPa) over the 96 hrs after the initial dose (p = .021 by repe
ated-measures analysis of variance). The average P(A-a)O-2 decreased f
rom 635 +/- 10 to 499 +/- 77 torr (84.7 +/- 1.3 to 66.5 +/- 10.3 kPa)
over the same time period (p = .059), while the mean static pulmonary
compliance (normalized for patient weight) increased from 0.12 +/- 0.0
2 to 0.28 +/- 0.08 mL/cm H2O/kg (p = .01). All six patients survived.
Complications potentially associated with partial liquid ventilation w
ere limited to pneumothoraces in two of six patients. Conclusions: Per
fluorocarbon may be safely administered into the lungs of pediatric pa
tients with severe respiratory failure on ECLS and may be associated w
ith improvement in gas exchange and pulmonary compliance.