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Published ahead of print on October 27, 2005, doi:10.1164/rccm.200508-1196OC

Am. J. Respir. Crit. Care Med., Volume 173, Number 8, April 2006, 882-889

A more recent version of this article appeared on April 15, 2006
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Submitted on August 3, 2005
Accepted on October 24, 2005

Partial Liquid Ventilation in Adult Patients with the Acute Respiratory Distress Syndrome

Robert M Kacmarek1*, Herbert P Wiedemann2, Philip T Lavin3, Mark K Wedel4, Ahmet S Tutuncu5, and Arthur S Slutsky6

1 Department of Anesthesia, Harvard Medical School, Boston, MA, USA; Respiratory Care, Massachusetts General Hospital, Boston, MA, USA, 2 Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA, 3 Averion Inc. and Boston Biostatistics Research Foundation, Inc, Framingham, MA, USA, 4 Medical Affairs, Alliance Pharmaceutical Corp, San Diego, CA, USA, 5 Clinical Research, Alliance Pharmaceutical Corp, San Diego, CA, USA, 6 Departments of Medicine, Surgery and Biomedical Engineering, University of Toronto, St. Michael's Hospital, Toronto, Canada

* To whom correspondence should be addressed. 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 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, tidal volume ≤ 10 mL/kg predicted body weight, rate ≤ 25/min, I:E ≤1:1, FIO2 ≥ 0.5 and PEEP ≥ 13 cmH2O. Results: The 28-day 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 to CMV and cannot be recommended for patients with ARDS.
Key words: Acute respiratory distress syndrome, liquid ventilation, partial liquid ventilation, mechanical ventilation




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