Combined gas ventilation and perfluorochemical tracheal instillation as an alternative treatment for lethal congenital diaphragmatic hernia in lambs

Major, Diane; Cadenas, M.; Galvez‐Cloutier, Rosa; Fournier, Louis; Wolfson, M. R.; Shaffer, Thomas H.

doi:10.1016/0022-3468(95)90016-0

Cited by 51 publications

(22 citation statements)

References 13 publications

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“…1 59 ) (see Clinical Studies) have proven informative to delineate the degree of pulmonary hypoplasia, as well as the relationship between PFC physicochemical properties, distribution, and elimination pattern of the PFC liquid. 29,52,54,55,[60][61][62] Conventionally, the ability to evaluate small airway pathology with bronchographic agents has been limited by poor resolution of the bronchioles at the secondary lobule level. 63 Because of its density, low surface tension, and intense radiopacity, perflubron has been used as a bronchographic contrast agent for HRCT.…”

Section: 12mentioning

confidence: 99%

“…120,121 The PFC liquid is oxygenated and CO 2 is removed from the lung as tidal volumes of gas are delivered by a mechanical gas ventilator. Various techniques have been explored for instilling the PFC liquid in the lungs in preparation for PLV, including brief periods (3-5 min) of TLV, 4,122,123 rapid instillation of a bolus (30 ml/kg) of oxygenated PFC with the ventilator disconnected, 119,120 as well as a slow infusion of oxygenated or room air equilibrated PFC in doses up to 30 ml/kg 60,118,[124][125][126][127][128][129][130][131] during continuous gas ventilation across a range of breathing frequencies in a variety of large and small animal preparations with acute RDS, aspiration syndromes, as well as lung hypoplasia due to congenital diaphragmatic hernia. Technically, the process of instilling PFC liquid and adjustment of the gas ventilator are familiar to the clinician (see Clinical Care During Partial Liquid Ventilation); however, effective ventilation of a lung which is partly filled with liquid and partly filled with gas is more challenging, since there are many unknowns with respect to the distribution of PFC fluid in the lung, oxygen and carbon dioxide saturation of resident PFC, continually changing lung mechanics, evaporative loss of PFC, and changing distribution and volumes of gas and PFC liquid within the lung.…”

Section: Partial Liquid Ventilation Techniquementioning

confidence: 99%

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Liquid-assisted ventilation: An alternative respiratory modality

1998

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Section: 12mentioning

confidence: 99%

Section: Partial Liquid Ventilation Techniquementioning

confidence: 99%

Liquid-assisted ventilation: An alternative respiratory modality

1998

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“…1,6,7,16,18 -23 Animal studies of liquid ventilation for models of ARDS and CDH have demonstrated improved lung function when compared with gas ventilation. 18,19 Previous human trials have shown the feasibility of PLV in improving lung function in critically ill infants and adults. The improvement in pulmonary compliance with PLV observed in the present study was more gradual when compared with experience in animals and preterm infants with respiratory distress syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Although PLV may optimally recruit lung volume in patients with CDH, severe pulmonary hypertension and hypoplasia may only resolve with prolonged or in utero therapy. 19 PLV therapy for infants with ARDS seems to have a great deal of promise. Based on this and other phase I and II trials, studies of PLV on full-term infants with ARDS before ECLS have been initiated.…”

Section: Discussionmentioning

confidence: 99%

Partial Liquid Ventilation in Critically Ill Infants Receiving Extracorporeal Life Support

et al. 1997

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ABSTRACT. Objectives. To demonstrate that a period of partial liquid ventilation (PLV) with perflubron improves pulmonary function, without adverse events, in a select group of critically ill infants receiving extracorporeal life support (ECLS) with a high likelihood of mortality.Methods. This was an open-label, noncontrolled, phase I and II trial of PLV in two infants with congenital diaphragmatic hernia and four infants with acute respiratory distress syndrome (ARDS) who were failing to improve while receiving ECLS. PLV was performed by instilling and maintaining a functional residual capacity of sterile perflubron for 4 to 96 hours.Results. Four infants were successfully weaned off ECLS for at least 3 days, and two infants (both with ARDS) are long-term survivors after PLV. All infants demonstrated lung recruitment and improved lung compliance, and there were no adverse events related to PLV.Conclusions. The study suggests that perflubron PLV is safe, improves lung function, and recruits lung volume in critically ill infants receiving ECLS. PLV therapy for infants with ARDS seems to have a great deal of promise. Based on this and other phase I and II trials, studies of PLV on selected full-term infants before ECLS have been initiated. Pediatrics 1997;99(1). URL: http://www. pediatrics.org/cgi/content/full/99/1/e2; congenital diaphragmatic hernia, acute respiratory distress syndrome, partial liquid ventilation, extracorporeal life support.ABBREVIATIONS. ECLS, extracorporeal life support; ARDS, acute respiratory distress syndrome; CDH, congenital diaphragmatic hernia; PLV, partial liquid ventilation; FRC, functional residual capacity.Perfluorochemicals have been explored as respiratory media for more than 20 years in many animal models of respiratory disease and, more recently, in initial phase I and II human trials of liquid ventilation.1-7 These chemicals are very stable, have low surface tension, are generally insoluble in water or lipid, and are excellent solvents for respiratory gases. The effectiveness of liquid ventilation is achieved, in part, through recruitment of collapsed gas-exchanging units, increasing lung compliance, and cleansing the lung of pulmonary debris. Sterile perflubron (LiquiVent; Alliance Pharmaceutical Corp, San Diego, CA), is one of very few perfluorochemicals that is produced as a medical-grade drug. The compound has an impressive biocompatibility profile in animals and humans and is the only fluid that is approved by the Federal Food and Drug Administration for testing as a breathing agent. Perflubron has a high solubility for respiratory gases, a positive spreading coefficient on saline, and a low viscosity and is highly radiopaque on plain radiograph or computed tomographic imaging. 8,9 Recent advances in respiratory therapies for the critically ill neonates have expanded the treatment options for infants with severe respiratory failure. In those severely effected infants, extracorporeal life support (ECLS) may result in increased survival. Nevertheless, morbidity remains high, ...

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“…[182][183][184] Lung compliance and gas exchange in infants and lambs with CDH improved significantly during PLV. [184][185][186] The perivascular emphysema observed in control lambs and in those treated with PLV is possibly caused by barotrauma developing during conventional ventilation in the first 30 minutes. It is, therefore, essential to conduct further studies in an attempt to define the ventilatory strategy that might avoid lung damage.…”

Section: Therapies To Reduce Lung Damage In Cdhmentioning

confidence: 93%