Partial Liquid Ventilation Improves Oxygenation and Lung Compliance in Children with Severe Hypoxaemic Respiratory Failure

Overview

Objective:
1. To test the effect of partial liquid ventilation, PLV, on gas exchange, in particular oxygenation, in critically ill pediatric patients with serious hypoxaemic respiratory failure - AHRF. 2. To test the effect of PLV on mechanical properties of the lungs (compliance) of critically ill pediatric patients with severe hypoxaemic respiratory failure.Type of study: Prospective observational study from January 1994 to December 1998.Place: ARO and ECMO centre, University Hospital Brno, Childrens Hospital.Patients: 14 patients with acute hypoxaemic respiratory failure, mean age 20.6 months, mean weight 7.9 kg and mean PRISM score 22.6 who were admitted to our department for possible extracorporeal oxygenation (ECMO). Method: The patients were treated according to the protocol for ALI/ARDS which comprises optimalization of conventional mechanical ventilation with recruitment manoeuvres, prone position, inhaled nitric oxide and tracheal gas insufflation, as well as high-frequency oscillation and ECMO. When ECMO was contraindicated or when in patients after five days on ECMO pulmonary functions did not improve, PLV was administered - 30 ml/kg perfluorocarbon (PFC) RIMAR 101 by the intratracheal route with repetition of doses. The authors recorded demographic data of the patients, the baseline and total dose of PCF, the period of PLV, mortality and compared mean values of the acid-base equilibrium, alveoaloarterial oxygen difference, oxygenation index, PaO2/FiO2 ratio, dynamic lung compliance and setting of the ventilator during PLV with regard to values before the onset of PLV. Results: The mortality was 71.4% (10 of 14 patients), the mean duration of PLV was 29.5 hours. In the course of PLV a statistically significant improvement of pH, PaO2, AaDO2, oxygenation index, PaO2/FiO2 ratio and dynamic lung compliance occurred and a reduction of PaCO2. The authors achieved reduction of pressures in the airways and FiO2 and an increase of the tidal volume.Conclusion: Partial liquid ventilation improves significantly the gas exchange in critically ill children with severe hypoxaemic respiratory failure. Improved oxygenation is apparent immediately after the onset of liquid ventilation and persists throughout the period of application and is statistically significant.

Key words:
partial liquid ventilation, acute respiratory distress syndrome, ventilation, oxygenation, lung compliance in children