PARTIAL LIQUID VENTILATION WITH PERFLUBRON IN PREMATURE-INFANTS WITH SEVERE RESPIRATORY-DISTRESS SYNDROME

Background The intratracheal administration of a perfluorocarbon liqui d during continuous positive-pressure ventilation (partial liquid vent ilation) improves lung function in animals with surfactant deficiency. Whether partial liquid ventilation is effective in the treatment of i nfants with severe respiratory distress syndrome is not known. Methods We studied the efficacy of partial liquid ventilation with perflubron in 13 premature infants with severe respiratory distress syndrome in whom conventional treatment, including surfactant therapy, had failed. Partial liquid ventilation was initiated by instilling perflubron dur ing conventional mechanical ventilation to a volume approximating the functional residual capacity. Infants were considered to have complete d the study if they received partial liquid ventilation for at least 2 4 hours. Results Ten infants received partial liquid ventilation for 2 4 to 76 hours. In the other th ree infants, partial liquid ventilation was discontinued within four hours in favor of high-frequency ventila tion, which was not permitted by the protocol, and the data from these infants were excluded from the analysis. Within one hour after the in stillation of perflubron, the arterial oxygen tension increased by 138 percent and the dynamic compliance increased by 61 percent; the mean (+/-SD) oxygenation index was reduced from 49+/-60 to 17+/-16. Chest r adiographs showed symmetric filling, with patchy clearing during the r eturn from partial liquid to gas ventilation. There were no adverse ev ents clearly attributable to partial liquid ventilation, Infants were weaned from partial liquid to gas ventilation without complications. E ight infants survived to 36 weeks' corrected gestational age. Conclusi ons Partial liquid ventilation leads to clinical improvement and survi val in some infants with severe respiratory distress syndrome who are not predicted to survive. (C) 1996, Massachusetts Medical Society.