Perfluorocarbon Liquid Ventilation in Pediatric ALI

Abstract

The response of infants and children to pulmonary injury or inflammatory stim-ulation, like that of the adult, triggers a final common pathway that has come to be known as acute lung injury (ALI). If sufficiently severe, the disorder has been termed acute respiratory distress syndrome (ARDS). In ALI, capillary permeabil-ity to water and large molecules increases. Water and protein leak from pulmo-nary capillary to lung interstitium. The alveolar basement membrane is less permeable to these substances than is the capillary basement membrane, so fluid accumulates in the interstitium of the lung. Pulmonary lymphatics drain the interstitium, and can substantially increase their intrinsic flow rates, but, if this is not sufficient to limit interstitial fluid accumulation, the dam bursts, and intersti-tial fluid and protein begin to leak into alveoli. This liquid impairs surfactant function, raising alveolar surface tension.