INITIAL EXPERIENCE WITH PARTIAL LIQUID VENTILATION IN PEDIATRIC-PATIENTS WITH THE ACUTE RESPIRATORY-DISTRESS SYNDROME

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.