Advertisement

Liquid ventilation: recent concepts

  • J. H. Arnold
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)

Abstract

Perfluorocarbon (PFC) liquids were first demonstrated to be suitable as an alternative respiratory medium by Clark and Gollan in 1966 and are characterized by the unique combination of high solubility for O2 and CO2, low surface tension, high spreading coefficient, and high density. However, attempts to utilize liquid media to enhance gas exchange significantly predate the development of perfluorochemical compounds. In the 1920s, saline lavage was utilized to treat victims of gas attacks during World War I and directly stimulated an interest in the use of liquid ventilation to support gas exchange during saline lavage. Evaluation of the feasibility of liquid ventilation was propelled further by U.S. government-sponsored research efforts involving ultradeep diving and the potentially fatal physiologic changes associated with rapid descent and subsequent ascent. Physiologic studies of the saline-filled lung demonstrated alveolar recruitment, increase in lung compliance and a homogenization of the distribution of regional pulmonary blood flow. In 1966, Kylstra [1] performed the first liquid breathing experiment using saline in a hyperbaric chamber and was able to support gas exchange in animals for 60 min. Subsequently, a biochemical search began to identify liquids with low surface tension, high solubilities for O2 and CO2, as well as immiscibility and nontoxicity. In 1966, Clark and Gollan performed the first liquid breathing experiment under normobaric conditions using a perfluorocarbon [2].

Keywords

Acute Lung Injury High Frequency Oscillation High Frequency Oscillatory Ventilation Injured Lung 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.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Kylstra JA, Paganelly CV, Lantieri CJ (1964) Pulmonary gas exchange in dogs ventilated with hyperbarically oxygenated liquid. J Appl Phys 21:177–184Google Scholar
  2. 2.
    Clark LC, Gollan F (1966) Survival of mammals breathing organic liquids equilibrated with oxygen at atmospheric pressure. Science 152:1755–1756PubMedCrossRefGoogle Scholar
  3. 3.
    Greenspan JS, Wolfson MR, Rubenstein SD et al (1990) Liquid ventilation of human preterm neonates. J Pediatr 117:106–111PubMedCrossRefGoogle Scholar
  4. 4.
    Fuhrman BP, Paczan PR, DeFrancisis M (1991) Perfluorocarbon-associated gas exchange. Crit Care Med 19:712–722PubMedCrossRefGoogle Scholar
  5. 5.
    Hirschl RB, Pranikoff T, Gauger P et al (1995) Liquid ventilation in adults, children, and full-term neonates. Lancet 346:1201–1202PubMedCrossRefGoogle Scholar
  6. 6.
    Shaffer TH, Rubenstein SD, Moskowitz D et al (1976) Gaseous exchange and acid-base balance in premature lambs during liquid ventilation since birth. Pediatr Res 10:227–231PubMedCrossRefGoogle Scholar
  7. 7.
    Hirschl RB, Parent A, Tooley R et al (1995) Liquid ventilation improves pulmonary function, gas exchange, and lung injury in a model of respiratory failure. Ann Surg 221:79–88PubMedCrossRefGoogle Scholar
  8. 8.
    Kylstra JA, Schoenfisch WH (1972) Alveolar surface tension in fluorocarbon-filled lungs. J Appl Physiol 33:32–35PubMedGoogle Scholar
  9. 9.
    Shaffer TH, Lowe CA, Bhutani VK et al (1984) Liquid ventilation: effects on pulmonary function in distressed meconium-stained lambs. Pediatr Res 18:47–52PubMedCrossRefGoogle Scholar
  10. 10.
    Wolfson MR, Greenspan JS, Deoras KS et al (1992) Comparison of gas and liquid ventilation: clinical, physiological, and histological correlates. J Appl Physiol 72:1024–1031PubMedGoogle Scholar
  11. 11.
    Leach CL, Fuhrman BP, Morin F III et al (1993) Perfluorocarbon-associated gas exchange (partial liquid ventilation) in respiratory distress syndrome: a prospective, randomized, controlled study. Crit Care Med 21:1270–1278PubMedCrossRefGoogle Scholar
  12. 12.
    Lowe CA, Shaffer TH (1986) Pulmonary vascular resistance in the fluorocarbon-filled lung. J Appl Physiol 60:154–159PubMedGoogle Scholar
  13. 13.
    Nesti FD, Fuhrman BP, Steinhorn DM et al (1994) Perfluorocarbon-associated gas exchange in gastric aspiration. Crit Care Med 22:1445–1452PubMedCrossRefGoogle Scholar
  14. 14.
    Tütüncü AS, Faithfull NS, Lachmann B (1993) Comparison of ventilatory support with intratracheal perfluorocarbon administration and conventional mechanical ventilation in animals with acute respiratory failure. Am Rev Respir Dis 148:785–792PubMedCrossRefGoogle Scholar
  15. 15.
    Smith TM, Steinhorn DM, Thusu K et al (1995) A liquid perfluorochemical decreases the in vitro production of reactive oxygen species by alveolar macrophages. Crit Care Med 23:1533–1539PubMedCrossRefGoogle Scholar
  16. 16.
    Thomassen MJ, Buhrow LT, Wiedemann HP (1997) Perflubron decreases inflammatory cytokine production by human alveolar macrophages. Crit Care Med 25:2045–2047PubMedCrossRefGoogle Scholar
  17. 17.
    Nesti FD, Fuhrman BP, Ballow M et al (1995) Modulation of PHA responsiveness with perflubron in acid aspiration pneumonitis. Crit Care Med 23:A213CrossRefGoogle Scholar
  18. 18.
    Varani J, Hirschl RB, Dame M et al (1996) Perfluorocarbon protects lung epithelial cells from neutrophil-mediated injury in an in vitro model of liquid ventilation therapy. Shock 6:339–344PubMedCrossRefGoogle Scholar
  19. 19.
    Lowe KC, Edwards CM, Röhlke W et al (1997) Perfluorochemical effects on neutrophil chemiluminescence. Adv Exp Med Biol 428:495–499PubMedCrossRefGoogle Scholar
  20. 20.
    Tütüncü 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
  21. 21.
    Mates EA, Hildebrandt J, Jackson JC et al (1997) Shunt and ventilation-perfusion distribution during partial liquid ventilation in healthy piglets. J Appl Physiol 82:933–942PubMedGoogle Scholar
  22. 22.
    Tarczy-Hornoch P, Hildebrandt J, Mates EA et al (1996) Effects of exogenous surfactant on lung pressure-volume characteristics during liquid ventilation. J Appl Physiol 80:1764–1771PubMedGoogle Scholar
  23. 23.
    Curtis SE, Peek JT, Kelly DR (1993) Partial liquid breathing with perflubron improves arterial oxygenation in acute canine lung injury. J Appl Physiol 75:2696–2702PubMedGoogle Scholar
  24. 24.
    Tütüncü AS, Lachmann B, Faithfull NS et al (1992) Dose-dependent improvement of gas exchange by intratracheal perflubron (perfluorooctylbromide) instillation in adult animals with acute respiratory failure. Adv Exp Med Biol 317:397–400PubMedCrossRefGoogle Scholar
  25. 25.
    Gauger PG, Pranikoff T, Schreiner RJ et al (1996) Initial experience with partial liquid ventilation in pediatric patients with the acute respiratory distress syndrome. Crit Care Med 24:16–22PubMedCrossRefGoogle Scholar
  26. 26.
    Hirschl RB, Pranikoff T, 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
  27. 27.
    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
  28. 28.
    Hernan LJ, Fuhrman BP, Kaiser RE et al (1996) Perfluorocarbon-associated gas exchange in normal and acid-injured large sheep. Crit Care Med 24:475–481PubMedCrossRefGoogle Scholar
  29. 29.
    Doctor A, Ibla JC, Grenier B et al (1998) Pulmonary blood flow distribution during partial liquid ventilation. J Appl Physiol 84:1540–1550PubMedGoogle Scholar
  30. 30.
    Leach CL, Fuhrman BP, Morin FC III et al (1993) Perfluorocarbon-associated gas exchange (partial liquid ventilation) in respiratory distress syndrome: a prospective, randomized, controlled study. Crit Care Med 21:1270–1278PubMedCrossRefGoogle Scholar
  31. 31.
    Hirschl RB, Tooley R, Parent AC et al (1995) Improvement of gas exchange, pulmonary function, and lung injury with partial liquid ventilation. Chest 108:500–508PubMedCrossRefGoogle Scholar
  32. 32.
    Hirschl RB, Overbeck MC, Parent A et al (1994) Liquid ventilation provides uniform distribution of perfluorocarbon in the setting of respiratory failure. Surgery 116:159–168PubMedGoogle Scholar
  33. 33.
    Kazerooni EA, Pranikoff T, Cascade PN et al (1996) Partial liquid ventilation with perflubron during extracorporeal life support in adults: radiographic appearance. Radiology 198:137–142PubMedGoogle Scholar
  34. 34.
    Garver KA, Kazerooni EA, Hirschl RB et al (1996) Neonates with congenital diaphragmatic hernia: radiographic findings during partial liquid ventilation. Radiology 200:219–223PubMedGoogle Scholar
  35. 35.
    Meaney JFM, Kazerooni EA, Garver KA et al (1997) Acute respiratory distress syndrome: CT findings during partial liquid ventilation. Radiology 202:570–573PubMedGoogle Scholar
  36. 36.
    Broccard AF, Shapiro RS, Schmitz LL et al (1997) Influence of prone position on the extent and distribution of lung injury in a high tidal volume oleic acid model of acute respiratory distress syndrome. Crit Care Med 25:16–27PubMedCrossRefGoogle Scholar
  37. 37.
    Gattinoni L, Pesenti A, Bombino M et al (1988) Relationships between lung computed tomographic density, gas exchange, and PEEP in acute respiratory failure. Anaesthesiology 69:824–832CrossRefGoogle Scholar
  38. 38.
    McCulloch PR, Forkert PG, Froese AB (1988) Lung volume maintenance prevents lung injury during high frequency oscillatory ventilation in surfactant-deficient rabbits. Am Rev Respir Dis 137:1185–1192PubMedGoogle Scholar
  39. 39.
    Froese AB, McCulloch PR, Sugiura M et al (1993) Optimizing alveolar expansion prolongs the effectiveness of exogenous surfactant therapy in the adult rabbit. Am Rev Respir Dis 148:569–577PubMedCrossRefGoogle Scholar
  40. 40.
    Cox PN, Morris K, Frndova H et al (1996) Relative distribution of gas and perfluorocarbon (PFC) during partial liquid ventilation. Pediatr Res 39:45ACrossRefGoogle Scholar
  41. 41.
    Baden HP, Mellema JD, Bratton SL et al (1997) High-frequency oscillatory ventilation with partial liquid ventilation in a model of acute respiratory failure. Crit Care Med 25:299–302PubMedCrossRefGoogle Scholar
  42. 42.
    Smith KM, Bing DR, Meyers PA et al (1997) Partial liquid ventilation: a comparison using conventional and high-frequency techniques in an animal model of acute respiratory failure. Crit Care Med 25:1179–1186PubMedCrossRefGoogle Scholar
  43. 43.
    Smith KM, Mrozek JD, Simonton SC et al (1997) Prolonged partial liquid ventilation using conventional and high-frequency ventilatory techniques: gas exchange and lung pathology in an animal model of respiratory distress syndrome. Crit Care Med 25:1888–1897PubMedCrossRefGoogle Scholar
  44. 44.
    Doctor A, Mazzoni MC, Del Balzo U et al (1998) High frequency oscillatory ventilation of the perfluorocarbon-filled lung: preliminary results in an animal model of acute lung injury. Crit Care Med (in press)Google Scholar

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • J. H. Arnold

There are no affiliations available

Personalised recommendations