Clinical correlation with changing radiographic appearance during partial liquid ventilation

Study objectives: To evaluate the chest radiographic filling pattern associ ated with partial liquid ventilation (PLV) with the perfluorochemical perfl ubron (LiquiVent; Alliance Pharmaceutical Corp; San Diego CA) as a function of dose and timing. Design: Post hoc review of chest radiographs by three independent observers with correlation to clinical variables. Setting: Phase II randomized, unco ntrolled, prospective, multicenter clinical trial. Patients: Sixteen adult patients with diffuse bilateral infiltrates consist ent with acute lung injury and a Pao(2)/fraction of inspired oxygen (FIO2) ratio < 300 with positive end-expiratory pressure of 13 cm H2O and FIO2 <gr eater than or equal to> 0.5. Interventions: All patients were treated with either a 10-mL/kg or 20-mL/kg loading dose of perflubron followed by maintenance dosing at 3-h intervals to protocol-determined levels. Results: There was a significant relationship between inhomogeneous radiogr aphic filling during the first 48 h of treatment and the use of the lower l oading dose of perflubron. Inhomogeneous radiographic filling (in 5 patient s) was associated with a lower high-dose/FIO2 ratio at 24 h compared with t he remaining patients. These differences resolved by 48 h. There were no ot her statistically significant correlations identified. Conclusions: The radiographic appearance of PLV with perflubron appears to depend on the dose administered. Lower doses can be associated with both in homogeneous radiographic filling and a transient deterioration in oxygenati on during the first 24 to 48 h of treatment.