Experience in Liquid Ventilation

  • R. B. Hirschl
Conference paper
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 30)

Abstract

Perfluorocarbons are structurally similar to hydrocarbons with the hydrogen replaced by fluorine. The carbon chains vary in length and an additional moiety often is attached to the molecule which, together, give unique properties to each perfluorocarbon. In general, perfluorocarbons have excellent oxygen and carbon dioxide carrying capacity (50 mL O2/dL and 160–210 mL C02/dL, respectively) [1]. They are clear, odorless, inert fluids which are immiscible in aqueous and most other solutions. They are relatively dense (1.7–1.9 g/mL),have a low surface tension (15–19 dynes/cm), and are relatively volatile with vapor pressures which range from 11 to 85 torr at 37°C. The vapor pressure of the individual perfluorocarbon governs the rapidity with which it evaporates from the lungs after intratracheal administration. As is demonstrated in fig. 1, perflubron (LiquiVent®, Alliance pharmaceutical Corp., san Diego, CA), which is currently the perflourocarbon most commonly used in clinical studies, is radiopaque, although this is not a characteristic of all of these fluids.

Keywords

Congenital Diaphragmatic Hernia Congenital Diaphragmatic Hernia Alveolar Recruitment Pulmonary Compliance Partial Liquid Ventilation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Shaffer TH, Wolfson MR, Clark L, Jr (1992) Liquid ventilation. Pediatr Pulmonol 14: 102 – 109PubMedCrossRefGoogle Scholar
  2. 2.
    Clark LC Jr, Gollan F (1966) Survival of mammals breathing organic liquids equilibrated with oxygen at atmospheric pressure. Science 152: 1755 – 1756PubMedCrossRefGoogle Scholar
  3. 3.
    Shaffer TH, Moskowitz GD (1974) Demand–controlled liquid ventilation of the lungs. J Appi Physiol 36: 208 – 213Google Scholar
  4. 4.
    Greenspan JS, Wolfson MR, Rubenstein SD, Shaffer TH (1989) Liquid ventilation of preterm baby. Lancet 2: 1095PubMedCrossRefGoogle Scholar
  5. 5.
    Greenspan JS, Wolfson MR, Rubenstein SD, Shaffer TH (1990) Liquid ventilation of human preterm neonates. J Pediatr 117: 106 – 111PubMedCrossRefGoogle Scholar
  6. 6.
    Hirschl RB, Merz S, Montoya P, et al (1995) Development of a simplified liquid ventilator. Crit Care Med 23: 157 – 163PubMedCrossRefGoogle Scholar
  7. 7.
    Fuhrman BP, Paczan PR, DeFrancisis M (1991) Perfluorocarbon–associated gas exchange. Crit Care Med 19: 712 – 722PubMedCrossRefGoogle Scholar
  8. 8.
    Leach CL, Fuhrman BP, Morin Fd, Rath MG (1993) Perfluorocarbon–associated gas exchange (partial liquid ventilation) in respiratory distress syndrome: A prospective, randomized, controlled study. Crit Care Med 21: 1270 – 1278PubMedCrossRefGoogle Scholar
  9. 9.
    Overbeck MC, Pranikoff T, Yadao CM, Hirschl RB (1996) The efficacy of perfluorocarbon liquid ventilation in a large animal model of acute respiratory failure. Crit Care Med 24: 1208 – 1214PubMedCrossRefGoogle Scholar
  10. 10.
    Hirschl RB, Tooley R, Parent AC, et al (1995) Improvement of gas exchange, pulmonary function, and lung injury with partial liquid ventilation. A study model in a setting of severe res¬piratory failure. Chest 108: 500 – 508PubMedCrossRefGoogle Scholar
  11. Hernán LJ, Fuhrman BP, Kaiser R, et al (1995) Perfluorocarbon associated gas exchange in normal and acid–injured–large sheep. Crit Care Med 23 (Suppl): A264 (Abst)Google Scholar
  12. 12.
    Nesti FD, Fuhrman BP, Papo MC, et al (1994) Perfluorocarbon–associated gas exchange in gastric aspiration. Crit Care Med 22: 1445 – 1452PubMedCrossRefGoogle Scholar
  13. 13.
    Tutuncu AS, Faithfull NS, Lachmann B (1993) Intratracheal perfluorocarbon administration combined with mechanical ventilation in experimental respiratory distress syndrome: Dose–dependent improvement of gas exchange. Crit Care Med 21: 962 – 969PubMedCrossRefGoogle Scholar
  14. 14.
    Tooley R, Hirschl RB, Parent A, Bartlett RH (1996) Total liquid ventilation with perfluorocar–bons increases pulmonary end–expiratory volume and compliance in the setting of lung atelectasis. Crit Care Med 24: 268 – 273PubMedCrossRefGoogle Scholar
  15. 15.
    Gattinoni L, D’Andrea L, Pelosi P, et al (1993) Regional effects and mechanism of positive end–expiratory pressure in early adult respiratory distress syndrome. JAMA 269: 2122 – 2127PubMedCrossRefGoogle Scholar
  16. 16.
    Hirschl RB, Overbeck MC, Parent A, et al (1994) Liquid ventilation provides uniform distribution of perfluorocarbon in the setting of respiratory failure. Surgery 116: 159 – 167PubMedGoogle Scholar
  17. 17.
    Quintel M, R.B. H, Roth H, et al (1995) Assessment of perfluorocarbon (PFC) distribution during partial liquid ventilation (PLV) in the setting of acute respiratory failure. Am J Respir Crit Care Med 151: A446 (Abst)Google Scholar
  18. 18.
    Gauger PG, Overbeck MC, Chamber SD, et al (1995) Perfluorocarbon partial liquid ventilation improves gas exchange while augmenting decreased functional residual capacity in an animal model of acute lung injury. Surgery Forum 46: 669 – 671Google Scholar
  19. Gauger PG, Overbeck MC, Koeppe RA, et al (1997) Distribution of pulmonary blood flow and total lung water during partial liquid ventilation in acute lung injury. Surgery (In press)Google Scholar
  20. Quintel M, Heine M, Hirschl RB, et al (1997) Effects of partial liquid ventilation (PLV) on lung injury in a model of acute respiratory failure a histologic and morphometric analysis. Crit Care Med (In press)Google Scholar
  21. Colton DM, Hirschl RB, Till GO, et al (1997) Neutrophil accumulation is reduced during partial liquid ventilation. Crit Care Med (In press)Google Scholar
  22. Colton DM, Hirschl RB, Till GO, et al (1995) Lung vascular permeability is reduced during partial liquid ventilation (PLV) in the setting of respiratory failure. Am J Respir Crit Care Medl51: A446 (Abst)Google Scholar
  23. 23.
    Smith T, Steinhorn D, Marcucci K, et al (1994) Perflubron (PFB) decreases free radical (FR) production by alveolar macrophages (A–) in vitro. Crit Care Med 22: A196 (Abst)Google Scholar
  24. 24.
    Virmani R, Fink LM, Gunter K, English D (1984) Effect of perfluorochemical blood substitutes on human neutrophil function. Tranfusion 24: 343 – 347CrossRefGoogle Scholar
  25. 25.
    Varani, Hirschl RB, Dame M, Johnson K (1996) Perfluorocarbon protects lung epithelial cells from neutrophil–mediated injury in an in vitro model of liquid ventilation therapy. Shock 6: 339 – 344PubMedCrossRefGoogle Scholar
  26. 26.
    Wilcox DT, Glick PL, Karamanoukian HL, et al (1995) Perfluorocarbon–associated gas exchange improves pulmonary mechanics, oxygenation, ventilation, and allows nitric oxide delivery in the hypoplastic lung congenital diaphragmatic hernia lamb model. Crit Care Med 23: 1858 – 1863PubMedCrossRefGoogle Scholar
  27. 27.
    Hirschl RB, Pranikoff P, Wise C, et al (1996) Initial experience with partial liquid ventilation in adult patients with the acute respiratory distress syndrome. JAMA 275: 383 – 389PubMedCrossRefGoogle Scholar
  28. 28.
    Leach CL, Greenspan JS, Rubenstein SD, et al (1996) Partial liquid ventilation with perflubron in premature infants with severe respiratory distress syndrome. N Engl J Med 335: 761 – 767PubMedCrossRefGoogle Scholar
  29. 29.
    Hirschl RB, Pranikoff T, Gauger P, et al (1995) Liquid ventilation in adults, children, and full–term neonates: Preliminary report. Lancet 346: 1201 – 1202PubMedCrossRefGoogle Scholar
  30. 30.
    Pranikoff T, Gauger P, Hirschl RB (1996) Partial liquid ventilation in newborn patients with congenital diaphragmatic hernia. J Ped Surg 31: 613 – 618CrossRefGoogle Scholar
  31. 31.
    Gauger PG, Pranikoff T, Schreiner RJ, Hirschl RB (1996) Initial experience with partial liquid ventilation in pediatric patients with the acute respiratory distress syndrome. Crit Care Med 24: 16 – 22PubMedCrossRefGoogle Scholar
  32. 32.
    Kazerooni EA, Pranikoff T, Cascade PN, Hirschl RB (1996) Perfluorocarbon partial liquid ventilation during extracorporeal life support in adults: radiographic appearance. Radiolo¬gy 198: 137 – 142Google Scholar
  33. 33.
    Toro–Figueroa LO, Melinoes JN, Curtis SE, et al (1996) Perflubron partial liquid ventilation (PLV) in children with ARDS: A safety and efficacy pilot study. Crit Care Med 24: A150 (Abst)Google Scholar
  34. 34.
    Hirschl RB (1997) Pulmonary function during liquid ventilation. In: Donn S (ed) Neonatal and pediatric pulmonary graphic analysis: Principles and clinical applications. Futura, Mount Kisco, NY (In press)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1998

Authors and Affiliations

  • R. B. Hirschl

There are no affiliations available

Personalised recommendations