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Published ahead of print on October 27, 2005, doi:10.1164/rccm.200508-1196OC
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American Journal of Respiratory and Critical Care Medicine Vol 173. pp. 882-889, (2006)
© 2006 American Thoracic Society
doi: 10.1164/rccm.200508-1196OC

Original Article

Partial Liquid Ventilation in Adult Patients with Acute Respiratory Distress Syndrome

Robert M. Kacmarek, Herbert P. Wiedemann, Philip T. Lavin, Mark K. Wedel, Ahmet S. Tütüncü and Arthur S. Slutsky

Department of Anesthesia and Critical Care, Harvard Medical School, and Respiratory Care, Massachusetts General Hospital, Boston; Averion, Inc.; Boston Biostatistics Research Foundation, Inc., Framingham, Massachusetts; Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, Ohio; Clinical Research Alliance Pharmaceutical Corporation, San Diego, California; and St. Michael's Hospital, and Departments of Medicine, Surgery, and Biomedical Engineering, University of Toronto, Toronto, Canada

Correspondence and requests for reprints should be addressed to Robert M. Kacmarek, Ph.D., R.R.T., Respiratory Care, Ellison 401, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail: rkacmarek{at}partners.org

Rationale: Despite recent clinical trials demonstrating improved outcome in acute respiratory distress syndrome (ARDS), mortality remains high. Partial liquid ventilation (PLV) using perfluorocarbons has been shown to improve oxygenation and decrease lung injury in various animal models.

Objective: To determine if PLV would have an impact on outcome in patients with ARDS.

Methods: Patients with ARDS were randomized to (1) conventional mechanical ventilation (CMV; n = 107), (2) "low-dose" perfluorocarbon (10 ml/kg; n = 99), and (3) "high-dose" perfluorocarbon (20 ml/kg; n = 105). Patients in all three groups were ventilated using volume ventilation, VT <= 10 ml/kg predicted body weight, rate <= 25/min, inspiratory-to-expiratory ratio <= 1:1, FIO2 >= 0.5, and positive end-expiratory pressure >= 13 cm H2O.

Results: The 28-d mortality in the CMV group was 15%, versus 26.3% in the low-dose (p = 0.06) and 19.1% in the high-dose (p = 0.39) PLV groups. There were more ventilator-free days in the CMV group (13.0 ± 9.3) compared with both the low-dose (7.4 ± 8.5; p < 0.001) and high-dose (9.9 ± 9.1; p = 0.043) groups. There were more pneumothoraces, hypoxic episodes, and hypotensive episodes in the PLV patients.

Conclusions: PLV at both high and low doses did not improve outcome in ARDS compared with CMV and cannot be recommended for patients with ARDS.

Key Words: acute respiratory distress syndrome • liquid ventilation • mechanical ventilation • partial liquid ventilation




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