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Liquid ventilation: An alternative ventilation strategy for management of neonatal respiratory distress

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Abstract

Perfluorochemical (PFC) liquids have great potential for biomedical use and the support of respiration. Currently, there are several commercially available PFC fluids which meet the physiochemical property requirements as well as purity specifications necessary to perform many of the discussed biomedical applications. Moreover, state-of-the-art fluorine chemistry should enable production of new PFC liquids uniquely sculptured relative to the proposed specific application (ie. vehicle for pulmonary delivery of drugs, a diluent for pulmonary lavage, a medium for respiratory gas exchange). In addition to PFC fluid requirements, there have been several techniques reported for liquid assisted ventilation. These methods include total liquid ventilation, liquid lavage, and partial liquid ventilation. The efficacy of these various techniques is under extensive investigation with respect to specific types of lung dysfunction. Liquid ventilation (LV) techniques have the potential to treat lung disease with less risk of barotrauma and provide the means for direct and uniform delivery of pulmonary agents to injured or dysfunctional sites in the lung. For LV to assume a role in clinical medicine it must be shown to be safe and effective with respect to other therapies or in combination with current therapies. Although the use of LV in animal and initial clinical studies has been impressive to date, better documentation of efficacy in human disease will be required. Further controlled multi-center clinical trials are warranted and are currently in progress.

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Abbreviations

ECMO :

extracorporal membrane oxygenation

GV :

gas ventilation

LV :

liquid ventilation

PFC :

perfluorochemical

PLV :

partial liquid ventilation

TLV :

total liquid ventilation

References

  1. Bhutani VK, Wolfson MR, Tran NN, Shaffer TH (1988) Liquid ventilation: postnatal cardiopulmonary conditioning of very preterm lambs. In: Jones CT (ed) Fetal and neonatal development. Perinatology Press, Ithaca NY, pp 304–308

    Google Scholar 

  2. Clark LC Jr, Gollan F (1966) Survival of mammals breathing organic liquids equilibrated with oxygen at atmospheric pressure. Science 152: 1755–1756

    PubMed  Google Scholar 

  3. Curtis SE, Peek JT, Kelly DR (1993) Partial liquid breathing with perflubron improves arterial oxygenation in acute canine lung injury. J Appl Physiol 75: 2696–2702

    PubMed  Google Scholar 

  4. DeLemos R, Winter D, Fields T, Dohertry T, Null D, Yoder B, Coalson J (1994) Prolonged partial liquid ventilation in the treatment of hyaline membrane disease (HMD) in the premature baboon. Pediatr Res 35:A330

    Google Scholar 

  5. Fuhrman BP, Paczan PR, DeFrancisis M (1991) Perfluorocarbon-associated gas exchange. Crit Care Med 19: 712–722

    PubMed  Google Scholar 

  6. Gladstone IM, Ray AO, Salafia CM, Perez-Fontan J, Mercurio M, Jacobs HC (1990) Effect of artificial surfactant on pulmonary function in preterm and fullterm lambs. J Appl Physiol 69: 465–472

    PubMed  Google Scholar 

  7. Greenspan JS, Wolfson MR, Rubenstein SD, Shaffer TH (1989) Liquid ventilation of preterm baby [letter]. Lancet II: 1095

    Article  Google Scholar 

  8. Greenspan JS, Wolfson MR, Rubenstein SD, Shaffer TH (1990) Liquid ventilation of human preterm neonates. J Pediatr 117: 106–111

    PubMed  Google Scholar 

  9. Gross GW, Greenspan JS, Fox WW, Rubenstein SD, Wolfson MR, Shaffer TH (1995) Use of liquid ventilation with Perflubron during extracororeal membrane oxygenation: chest radiographic appearances. Radiology 194 (3): 717–720

    PubMed  Google Scholar 

  10. Hirschl RB, Bartlett RH (1988) Extracorporeal membrane oxygenation support in cardiorespiratory failure. Adv Surg 21: 189–211

    PubMed  Google Scholar 

  11. Hirschl RB, Parent A, Tooley R, Shaffer T, Wolfson M, Bartlett RH (1994) Lung management with perfluorocarbon liquid ventilation improves pulmonary function and gas exchange during extracorporeal membrane oxygenation (ECMO). Art Cells Blood Subs, and Immob Biotech 22 (4): 1389–1396

    Google Scholar 

  12. Hirschl RB, Pranikoff T, Gauger P, Schreiner RJ, Dechert R, Bartlett RH (1995) Liquid ventilation in adults, children, and full-term neonates. Lancet 346: 1201–1202

    Article  PubMed  Google Scholar 

  13. Koen PA, Wolfson MR, Shaffer TH (1988) Fluorocarbon ventilation: maximal expiratory flows and CO2 elimination. Pediatr Res 24: 291–296

    PubMed  Google Scholar 

  14. Kylstra JA, Paganelli CV, Lanphier EH (1966) Pulmonary gas exchange in dogs ventilated with hyperbarically oxygentated liquid. J Appl Physiol 21: 177–184

    PubMed  Google Scholar 

  15. Leach CL, Fuhrman BP, Morin FC, Rath MG (1993) Perfluorocarbon-associated gas exchange (partial liquid ventilation) in respiratory distress syndrome: a prospective, randomized, controlled study. Crit Care Med 21: 1270–1278

    PubMed  Google Scholar 

  16. Leach CL, Greenspan JS, Rubenstein SD, Shaffer TH, Wolfson MR, Jackson JC, DeLemos R, Fuhrman BP (1995) Partial liquid ventilation with LiquiVent: A pilot and safety and efficacy study in premature newborns with severe respiratory distress syndrome (RDS). Pediatr Res 37: 220

    Google Scholar 

  17. Lowe CA, Shaffer TH (1986) Pulmonary vascular resistance in the fluorocarbon-filled lung. J Appl Physiol 60: 154–159

    PubMed  Google Scholar 

  18. Major D, Cadenas M, Cloutier R, Fourier L, Shaffer TH, Wolfson MR (1995) Combined ventilation and perfluorochemical (PFC) tracheal instillation as an alternative treatment for near-death congenital diaphragmatic hernia. J Pediatr Surg 30: 1178–1182

    Article  PubMed  Google Scholar 

  19. Moskowitz GD (1970) A mechanical respirator for control of liquid breathing. Fed Proc 29: 1751–1752

    PubMed  Google Scholar 

  20. Richman PS, Wolfson MR, Shaffer TH (1993) Lung lavage with oxygenated perfluorochemical liquid in acute lung injury. Crit Care Med 21: 768–774

    PubMed  Google Scholar 

  21. Riess JG (1992) Overview of progress in the fluorocarbon approach to in vivo oxygen delivery. [Review]. Art Cells, Blood Subs, and Immob Biotech 20–24

  22. Schoenfish WH, Kylstra JA (1973) Maximum expiratory flow and estimated CO2 elimination in liquid-ventilated dog's lungs. J Appl Physiol 35: 117–121

    PubMed  Google Scholar 

  23. Shaffer TH (1987) A brief review: liquid ventilation. Undersea Biomed Res 14 (2): 169–178

    PubMed  Google Scholar 

  24. Shaffer TH, Moskowitz GD (1975) An electromechanical demand regulated liquid breathing system. IEEE Transactions on Biomedical Engineering 22 (5): 412–417

    PubMed  Google Scholar 

  25. Shaffer TH, Wolfson MR (1992) Principles and applications of liquid breathing: water babies revisited. In: Klaus MH, Fanaroff AA (eds) Yearbook of neonatal and perinatal medicine. Mosby-Year Book, St. Louis ER

    Google Scholar 

  26. Shaffer TH, Rubenstein D, Moskowitz D, Delivoria-Papadopoulos M (1976) Gaseous exchange and acid-base balance in premature lambs during liquid ventilation since birth. Pediatr Res 10 (4): 227–231

    PubMed  Google Scholar 

  27. Shaffer TH, Ferguson JD, Koen PA, Moskowitz GD, Delivoria-Papadopoulos M (1978) Pulmonary lavage in preterm lambs. Pediatr Res 12 (6): 695–698

    PubMed  Google Scholar 

  28. Shaffer TH, Douglas PR, Lowe CA, Bhutani VK (1983) The effects of liquid ventilation on cardiopulmonary function in preterm lambs. Pediatr Res 17 (4): 303–306

    PubMed  Google Scholar 

  29. Shaffer TH, Tran N, Bhutani VK, Sivieri EM (1983) Cardiopulmonary function in very preterm lambs during liquid ventilation. Pediatr Res 17 (8): 680–684

    PubMed  Google Scholar 

  30. Shaffer TH, Lowe CA, Bhutani VK, Douglas PR (1984) Liquid ventilation: effects on pulmonary function in distressed meconium-stained lambs. Pediatr Res 18 (1): 47–52

    PubMed  Google Scholar 

  31. Shaffer TH, Wolfson MR, Clark LC (1992) State-of-the-art: liquid ventilation. Pediatr Pulmonol 14: 102–109

    PubMed  Google Scholar 

  32. Shaffer TH, Greenspan JS, Wolfson MR (1994) Liquid ventilation. In: Boynton BR, Carlo WA, Jobe AH (eds) New therapies for neonatal respiratory failure. A physiological approach. Cambridge University Press, New York, pp 279–301

    Google Scholar 

  33. Stern RG, Wolfson MR, McGuckin JF, Forge JA, Shaffer TH (1993) High-resolution computed tomographic bronchiolography using perfluoroctylbromide (PFOB): an experimental model. J Thorac Imaging 8: 300–304

    PubMed  Google Scholar 

  34. Tham MK, Walker RD, Modell JH (1973) Physical properties and gas solubilities in selected fluorinated ethers. J Chem Engin Data 18: 385–386

    Article  Google Scholar 

  35. Tutuncu AS, Faithfull NS, Lachmann B (1993) Comparison of ventilatory support with intratracheal 1. Avery ME, Mead J. Surface properties in relation to atelectasis and hyaline membrane disease. Am J Dis Child 97: 517–523

    Google Scholar 

  36. Wessler EP, Iltis R, Clark LC Jr (1977) The solubility of oxygen in highly fluorinated liquids. J Fluorine Chem 9: 137–146

    Article  Google Scholar 

  37. West JB, Dollery CT, Matthews CME, Zardini P (1965) Distribution of blood flow and ventilation in saline-filled lung. J Appl Physiol 20: 1107–1117

    Google Scholar 

  38. Wilcox DT, Glick PL, Karamanoukian HL, Morin FC, Fuhrman BP, Leach CL (1994) Perfluorocarbon associated gas exchange (PAGE) and nitric oxide in the lamb with congenital diaphragmatic hernia model. Pediatr Res 35: A260

    Google Scholar 

  39. Wolfson MR, Shaffer TH (1990) Liquid ventilation during early development: theory, physiologic processes and application. J Dev Physiol 13 (1): 1–12

    PubMed  Google Scholar 

  40. Wolfson MR, Tran N, Bhutani VK, Shaffer TH (1988) A new experimental approach for the study of cardiopulmonary physiology during early development. J Appl Physiol 65 (3): 1436–1443

    PubMed  Google Scholar 

  41. Wolfson MR, Greenspan JS, Shaffer TH (1991) Pulmonary administration of vasoactive drugs (PAD) by perfluorocarbon liquid ventilation. Pediatr Res 29: A336

    Google Scholar 

  42. Wolfson MR, Greenspan JS, Deoras KS, Rubenstein SD, Shaffer TH (1992) Comparison of gas and liquid ventilation: clinical, physiological, and histological correlates. J Appl Physiol 72: 1024–1031

    PubMed  Google Scholar 

  43. Wolfson MR, Friss HE, Billmire D; Hirschl RB, Shaffer TH (1994) Combined technologies: liquid ventilation (LV) and extracorporeal life support (ECLS) for treatment of severe neonatal lung injury. 10 Annual CNMC Symposium Keystone Co

  44. Wolfson MR, Friss HE, Kechner NE, Rubenstein SD, Dechadarevian JP, Shaffer TH (1994) Physiologic basis of improved lung stability after perfluorochemical (PFC) liquid rescue of surfactant treated lambs. Pediatr Res 35: A357

    Google Scholar 

  45. Wolfson MR, Kechner NE, Friss H, Rubenstein SD, Shaffer TH (1994) Improved gas exchange during and following slow tracheal instillation of perfluorochemical liquid in neonatal respiratory distress. Am J Respir Crit Care Med 149: A545

    Google Scholar 

  46. Wolfson MR, Stern RG, Kechner N, Sekins KM, Shaffer TH (1994) Utility of a perfluorochemical liquid for pulmonary diagnostic imaging. Art Cells, Blood Subs, and Immob Biotech 22: 1409–1420

    Google Scholar 

  47. Wolfson MR, Robinson N, Ginda M, Friss HE, Taulane J, Cox C, Billmire D, Foust R, Shaffer TH (1995) Combined technologies: Liquid ventilation (LV) and extracorporeal life support (ECLS) for treatment of meconium aspiration injury. 11th Annual CNMC ECMO Symposium Keystone CO

  48. Zelinka MA, Wolfson MR, Calligaro S, Rubenstein SD, Greenspan JS, Shaffer TH (1991) Direct administration of Gentamicin during liquid ventilation of the lamb: comparison of lung and serum levels to IV administration. Pediatr Res 29: A290

    Google Scholar 

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Shaffer, T.H., Wolfson, M.R. Liquid ventilation: An alternative ventilation strategy for management of neonatal respiratory distress. Eur J Pediatr 155 (Suppl 2), S30–S34 (1996). https://doi.org/10.1007/BF01958078

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  • DOI: https://doi.org/10.1007/BF01958078

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