Partial liquid ventilation in the therapy of pediatric acute respiratory distress syndrome.

BACKGROUND: Acute respiratory failure represents life-threatening disease with persistently marked mortality and late morbidity in pre-term newborns (RDS--respiratory distress syndrome), children as well as, adults (ARDS--acute respiratory distress syndrome). We are probably in the period when better understanding of pulmonary pathophysiology enables the development of new technologies that can help in decreasing the morbidity and mortality of patients with respiratory failure. One of these unconventional methods is partial liquid ventilation (PLV).

MAIN PURPOSE: The main aim of the study was to verify the possibility of treating potentially reversible respiratory failure in patients where extracorporeal life support (ECLS) was contraindicated and extracorporeal membrane oxygenation (ECMO) could not be used, or the patient had not met the criteria for ECMO.

METHODS: PLV was used in 6 children totally, in 7 applications with severe hypoxemic respiratory failure. Preoxygenated perfluorocarbon Rimar 101 (Miteni, Milan, Italy) warmed to 37 degrees C was applied intratracheally in the doses which corresponds with the functional residual capacity of lungs, the dose of perfluorocarbon was repeated every hour. Following parameters were recorded before, during and after PLV: pH, blood gases, ventilator setting, alveoloarterial difference for oxygen, dynamic compliance, and indices--oxygenation index and hypoxemia score (PaO2/FiO2). The values obtained 1 hour before PLV were compared with the values during PLV; the data before PLV and in the 3rd hour of PLV were evaluated statistically.

RESULTS: Statistically significant increase of pH (7.22 vs 7.34, p < 0.05) and PaO2/FiO2 (72 vs 100 Torr, p < 0.01) and decrease of FiO2 (82% vs 64%, p < 0.05) and oxygenation index (23 vs 17, p < 0.05) occurred during 3 hours of PLV.

CONCLUSION: Partial liquid ventilation is an effective method for controlling ARDS in certain groups of patients with severe lung disease. (Tab. 4, Ref. 15.)