Liquid Ventilation

Highlights from the Hot Topics in Neonatology Conference in Washington , D.C.
December 12-14 , 2004

Liquid Ventilation

LIQUID VENTILATION: YESTERDAY, TODAY AND TOMORROW.
Thomas H. Shaffer, MS, PhD. Director of the Nemorus Research Lung Center

Dr. Shaffer, spoke of YESTERDAY, and how 40 years ago researchers found that mice whose lungs were filled with an oxygenated saline solution could survive for several hours. In 1966, Clark and Gollan observed that oxygen and carbon dioxide are very soluble in certain SILICONE OILS and FLUOROCARBON LIQUIDS. Although animals that breathed the silicone oils died shortly after returning to breathing normal air., those that breathed liquid perfluorochemicals survived for weeks. In 1989, several premature babies underwent total liquid ventilation showing improvement in compliance and gas exchange. Lack of liquid ventilation technology and a pharmaceutical grade perfluorochemical prevented its advancement.

Liquid ventilation became possible with perfluorocarbon ( PFC ), a clear, colorless, odorless, non-conducting and non-flammable substance. PFC functioned as the carrier of oxygen and carbon dioxide. It may stay in the body for some time with no known untoward effects. It is excreted from the body after several years. These chemicals are lipid soluble, and they are totally insoluble in water.

PFC was found to be an excellent vehicle to carry respiratory gases and prevent alveolar collapse. They are not taken up by the body, but are evaporated by the lungs. They do not break down into toxic metabolites like high concentrations of gaseous oxygen. They even exhibit anti-oxidative properties.

The ALLIANCE CLINICAL TRIALS impeded the enthusiasm people had for PFC in the 1990’s. The study results did not show an increase in “ventilator free days” or “improvement in 28 day mortality”. It did show that PFC was well tolerated.

Dr. Shaffer also pointed out the technical problems associated with doing Total Liquid Ventilation (TLV). The lack of a liquid ventilator made this technique unfeasible. Instead, Partial Liquid Ventilation (PLV) was attempted. With this technique, the lungs are filled to functional residual capacity with PFC, then ventilated with our standard ventilators.

For TOMORROW, Dr. Shaffer stated there may be a role for the use of PFC in the 400-600 grams premature infants that continue to demonstrate significant pulmonary morbidity. There may also be a role for PFC in the treatment of babies with Congenital Diaphragmatic Hernia (CDH). The CURRENT RONALD HIRSCHL CDH TRIAL hypothesizes that use of PFC will lead to less ICU days, less ventilator days, less BPD and PILG (Perfluorocarbon-induced lung growth ).

Comments: This product has always stimulated hope in those patients at risk for developing severe lung injury. I hope in the future we can fine tune its uses and attain this outcome. EV.

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