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Am. J. Respir. Crit. Care Med., Volume 165, Number 6, March 2002, 781-787

Prospective, Randomized, Controlled Pilot Study of Partial Liquid Ventilation in Adult Acute Respiratory Distress Syndrome

RONALD B. HIRSCHL, MARTIN CROCE, DENNIS GORE, HERBERT WIEDEMANN, KEN DAVIS, JOSEPH ZWISCHENBERGER, and ROBERT H. BARTLETT, for the Adult Partial Liquid Ventilation Study Group

Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan; Department of Surgery, Memphis University, Memphis, Tennessee; Department of Surgery, Medical College of Virginia, Richmond, Virginia; Department of Surgery, University of Texas at Galveston, Galveston, Texas; Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio; and the Department of Surgery, University of Cincinnati, Cincinnati, Ohio

We evaluated the safety and efficacy of partial liquid ventilation (PLV) with perflubron in adult patients with acute lung injury and the acute respiratory distress syndrome (ARDS) in a multicenter, prospective, controlled, randomized exploratory clinical trial. Ninety adult patients with PaO2/FIO2 ratios > 60 and < 300 with ARDS for no more than 24 hours were randomized to receive PLV (n = 65) with administration of perflubron through an endotracheal tube sideport or conventional mechanical ventilation (CMV, n = 25) for a maximum of five days. Although a significant reduction in progression to ARDS was noted among patients with PLV, no significant differences in the number of days free from the ventilator at 28 days (CMV = 6.7 ± 1.8, PLV = 6.3 ± 1.0 days, p = 0.85), the incidence of mortality (CMV = 36%, PLV = 42%, p = 0.63), or any pulmonary-related parameter were observed. During a post hoc subgroup analysis, significantly more rapid discontinuation of mechanical ventilation (p = 0.045) and a trend toward an increase in the number of days free from the ventilator at 28 days (CMV = 3.2 ± 1.9, PLV = 8.0 ± 2.2 days, p = 0.06) were observed during PLV among those patients under 55 years of age with acute lung injury or ARDS. Episodes of hypoxia, respiratory acidosis, and bradycardia occurred more frequently in the PLV group, but these were transient and self-limited. Further evaluation of PLV is warranted to further define beneficial effects in well-defined groups of patients and also to gain additional information regarding safety.




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