- Karen J Tietze, PharmD
Karen J Tietze, PharmD
- Professor of Clinical Pharmacy
- Philadelphia College of Pharmacy
- University of the Sciences in Philadelphia
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
Liquid ventilation (LV) is a technique of mechanical ventilation in which the lungs are insufflated with an oxygenated perfluorochemical liquid rather than an oxygen-containing gas mixture. The use of perfluorochemicals, rather than nitrogen, as the inert carrier of oxygen and carbon dioxide offers a number of theoretical advantages for the treatment of acute lung injury, including:
●Reducing surface tension by maintaining a fluid interface with alveoli
●Opening of collapsed alveoli by hydraulic pressure with a lower risk of barotrauma
●Providing a reservoir in which oxygen and carbon dioxide can be exchanged with pulmonary capillary blood
●Functioning as a high efficiency heat exchanger
- Degraeuwe PL, Vos GD, Blanco CE. Perfluorochemical liquid ventilation: from the animal laboratory to the intensive care unit. Int J Artif Organs 1995; 18:674.
- Norris MK, Fuhrman BP, Leach CL. Liquid ventilation: it's not science fiction anymore. AACN Clin Issues Crit Care Nurs 1994; 5:246.
- KYLSTRA JA, TISSING MO, van der MAEN . Of mice as fish. Trans Am Soc Artif Intern Organs 1962; 8:378.
- Clark LC Jr, Gollan F. Survival of mammals breathing organic liquids equilibrated with oxygen at atmospheric pressure. Science 1966; 152:1755.
- Riess JG. Overview of progress in the fluorocarbon approach to in vivo oxygen delivery. Biomater Artif Cells Immobilization Biotechnol 1992; 20:183.
- Cox CA, Wolfson MR, Shaffer TH. Liquid ventilation: a comprehensive overview. Neonatal Netw 1996; 15:31.
- Shaffer TH. A brief review: liquid ventilation. Undersea Biomed Res 1987; 14:169.
- Shaffer TH, Wolfson MR, Clark LC Jr. Liquid ventilation. Pediatr Pulmonol 1992; 14:102.
- Greenspan JS. Physiology and clinical role of liquid ventilation therapy. J Perinatol 1996; 16:S47.
- Wolfson, MR, Kechner, NE, Rubenstein, D, et al. Perfluorochemical (PFC) uptake and biodistribution following liquid assisted ventilation in the immature lamb. Pediatr Res 1994; 35:A246.
- Gauthier SP, Wolfson MR, Deoras KS, Shaffer TH. Structure-function of airway generations 0 to 4 in the preterm lamb. Pediatr Res 1992; 31:157.
- Wolfson, MR, Clark, LC, Hoffmann, RE, et al. Liquid ventilation of neonates: Uptake, distribution, and elimination of the liquid. Pediatr Res 1990; 27:37A.
- Reickert C, Pranikoff T, Overbeck M, et al. The pulmonary and systemic distribution and elimination of perflubron from adult patients treated with partial liquid ventilation. Chest 2001; 119:515.
- Hagerty RD, Phelan MP, Morrison SC, Hatem SF. Radiographic detection of perflubron fluoromediastinum and fluororetroperitoneum 9 years after partial liquid ventilation. Emerg Radiol 2008; 15:71.
- Servaes S, Epelman M. Perflubron residua: 12 years following therapy. Pediatr Radiol 2009; 39:393.
- Dirkes S. Liquid ventilation: new frontiers in the treatment of ARDS. Crit Care Nurse 1996; 16:53.
- Koen PA, Wolfson MR, Shaffer TH. Fluorocarbon ventilation: maximal expiratory flows and CO2 elimination. Pediatr Res 1988; 24:291.
- Leach CL, Greenspan JS, Rubenstein SD, et al. Partial liquid ventilation with perflubron in premature infants with severe respiratory distress syndrome. The LiquiVent Study Group. N Engl J Med 1996; 335:761.
- Hirschl RB. Advances in the management of respiratory failure. Liquid ventilation in the setting of respiratory failure. ASAIO J 1996; 42:209.
- Kirmse M, Fujino Y, Hess D, Kacmarek RM. Positive end-expiratory pressure improves gas exchange and pulmonary mechanics during partial liquid ventilation. Am J Respir Crit Care Med 1998; 158:1550.
- Tütüncü AS, Faithfull NS, Lachmann B. Intratracheal perfluorocarbon administration combined with mechanical ventilation in experimental respiratory distress syndrome: dose-dependent improvement of gas exchange. Crit Care Med 1993; 21:962.
- Fuhrman BP, Paczan PR, DeFrancisis M. Perfluorocarbon-associated gas exchange. Crit Care Med 1991; 19:712.
- Berry D, Ikegami M, Jobe A. Respiratory distress and surfactant inhibition following vagotomy in rabbits. J Appl Physiol (1985) 1986; 61:1741.
- Lowe CA, Shaffer TH. Pulmonary vascular resistance in the fluorocarbon-filled lung. J Appl Physiol (1985) 1986; 60:154.
- Steinhorn DM, Leach CL, Fuhrman BP, Holm BA. Partial liquid ventilation enhances surfactant phospholipid production. Crit Care Med 1996; 24:1252.
- Richman PS, Wolfson MR, Shaffer TH. Lung lavage with oxygenated perfluorochemical liquid in acute lung injury. Crit Care Med 1993; 21:768.
- Angelova M, Nakazawa K, Yokoyama K, Makita K. Effects of partial liquid ventilation on lipopolysaccharide-induced inflammatory responses in rats. Resuscitation 2004; 62:89.
- Smith TM, Steinhorn DM, Thusu K, et al. A liquid perfluorochemical decreases the in vitro production of reactive oxygen species by alveolar macrophages. Crit Care Med 1995; 23:1533.
- Virmani R, Fink LM, Gunter K, English D. Effect of perfluorochemical blood substitutes on human neutrophil function. Transfusion 1984; 24:343.
- Varani J, Hirschl RB, Dame M, Johnson K. Perfluorocarbon protects lung epithelial cells from neutrophil-mediated injury in an in vitro model of liquid ventilation therapy. Shock 1996; 6:339.
- Koch T, Ragaller M, Haufe D, et al. Perfluorohexane attenuates proinflammatory and procoagulatory response of activated monocytes and alveolar macrophages. Anesthesiology 2001; 94:101.
- Nakstad B, Wolfson MR, Shaffer TH, et al. Perfluorochemical liquids modulate cell-mediated inflammatory responses. Crit Care Med 2001; 29:1731.
- Woods CM, Neslund G, Kornbrust E, Flaim SF. Perflubron attenuates neutrophil adhesion to activated endothelial cells in vitro. Am J Physiol Lung Cell Mol Physiol 2000; 278:L1008.
- Kelly KP. Partial liquid ventilation--turning back a PAGE on evolution. Br J Anaesth 1997; 78:1.
- Shaffer TH, Forman DL, Wolfson MR. Physiological effects of ventilation with liquid fluorocarbon at controlled temperatures. Undersea Biomed Res 1984; 11:287.
- Forman DL, Bhutani VK, Tran N, Shaffer TH. A new approach to induced hypothermia. J Surg Res 1986; 40:36.
- Antunes MJ, Greenspan JS, Zukowsky K. Advanced ventilation in the neonate. Nurs Clin North Am 1996; 31:405.
- Leach, CL, Holm, BA, Morin, FC, et al. Partial liquid ventilation with LiquiVent' increases endogenous surfactant production in premature lambs with respiratory distress syndrome (RDS). Pediatr Res 1994; 35:220A.
- Hirschl RB, Pranikoff T, Wise C, et al. Initial experience with partial liquid ventilation in adult patients with the acute respiratory distress syndrome. JAMA 1996; 275:383.
- Hirschl RB, Pranikoff T, Gauger P, et al. Liquid ventilation in adults, children, and full-term neonates. Lancet 1995; 346:1201.
- Shaffer TH, Lowe CA, Bhutani VK, Douglas PR. Liquid ventilation: effects on pulmonary function in distressed meconium-stained lambs. Pediatr Res 1984; 18:47.
- Pranikoff T, Gauger PG, Hirschl RB. Partial liquid ventilation in newborn patients with congenital diaphragmatic hernia. J Pediatr Surg 1996; 31:613.
- Wilcox DT, Glick PL, Karamanoukian HL, et al. Partial liquid ventilation and nitric oxide in congenital diaphragmatic hernia. J Pediatr Surg 1997; 32:1211.
- Major D, Cadenas M, Cloutier R, et al. Combined gas ventilation and perfluorochemical tracheal instillation as an alternative treatment for lethal congenital diaphragmatic hernia in lambs. J Pediatr Surg 1995; 30:1178.
- Wilcox DT, Glick PL, Karamanoukian HL, et al. Perfluorocarbon-associated gas exchange improves pulmonary mechanics, oxygenation, ventilation, and allows nitric oxide delivery in the hypoplastic lung congenital diaphragmatic hernia lamb model. Crit Care Med 1995; 23:1858.
- Cannon ML, Cheifetz IM, Craig DM, et al. Optimizing liquid ventilation as a lung protection strategy for neonatal cardiopulmonary bypass: full functional residual capacity dosing is more effective than half functional residual capacity dosing. Crit Care Med 1999; 27:1140.
- Hirschl RB, Parent A, Tooley R, et al. Liquid ventilation improves pulmonary function, gas exchange, and lung injury in a model of respiratory failure. Ann Surg 1995; 221:79.
- Cullen AB, Cox CA, Hipp SJ, et al. Intra-tracheal delivery strategy of gentamicin with partial liquid ventilation. Respir Med 1999; 93:770.
- Sekins KM, Deilman GW, Shaffer TH, et al. Acoustic and physical properties of PFC liquids pertinent to ultrasound lung hyperthermia. 10th Annual North American Hyperthermia Group. Radiation Res Soc. April, 1990.
- Wolfson MR, Greenspan JS, Shaffer TH. Pulmonary administration of vasoactive substances by perfluorochemical ventilation. Pediatrics 1996; 97:449.
- Dickson, EW, Heard, SO, Otto, S, et al. Efficacy of a novel perfluorocarbon-based intrapulmonary drug delivery system. Crit Care Med 1998; 26:143A.
- Franz AR, Röhlke W, Franke RP, et al. Pulmonary administration of perfluorodecaline- gentamicin and perfluorodecaline- vancomycin emulsions. Am J Respir Crit Care Med 2001; 164:1595.
- Dembinski R, Bensberg R, Marx G, et al. Semi-fluorinated alkanes as carriers for drug targeting in acute respiratory failure. Exp Lung Res 2010; 36:499.
- Orizondo RA, Babcock CI, Fabiilli ML, et al. Characterization of a reverse-phase perfluorocarbon emulsion for the pulmonary delivery of tobramycin. J Aerosol Med Pulm Drug Deliv 2014; 27:392.
- Yoshida S, Sekine Y, Shinozuka N, et al. The efficacy of partial liquid ventilation in lung protection during hypotension and cardiac arrest: preliminary study of lung transplantation using non-heart-beating donors. J Heart Lung Transplant 2005; 24:723.
- Loehe F, Mueller C, Bittmann I, et al. Influence of long-term preservation with endobronchially administered perfluorodecalin on pulmonary graft function. Transplantation 2000; 70:1417.
- Greenspan JS, Wolfson MR, Rubenstein SD, Shaffer TH. Liquid ventilation of human preterm neonates. J Pediatr 1990; 117:106.
- Hirschl RB, Conrad S, Kaiser R, et al. Partial liquid ventilation in adult patients with ARDS: a multicenter phase I-II trial. Adult PLV Study Group. Ann Surg 1998; 228:692.
- Gauger PG, Pranikoff T, Schreiner RJ, et al. Initial experience with partial liquid ventilation in pediatric patients with the acute respiratory distress syndrome. Crit Care Med 1996; 24:16.
- Greenspan JS, Fox WW, Rubenstein SD, et al. Partial liquid ventilation in critically ill infants receiving extracorporeal life support. Philadelphia Liquid Ventilation Consortium. Pediatrics 1997; 99:E2.
- Croce MA, Fabian TC, Patton JH Jr, et al. Partial liquid ventilation decreases the inflammatory response in the alveolar environment of trauma patients. J Trauma 1998; 45:273.
- Hirschl RB, Croce M, Gore D, et al. Prospective, randomized, controlled pilot study of partial liquid ventilation in adult acute respiratory distress syndrome. Am J Respir Crit Care Med 2002; 165:781.
- Hirschl RB, Philip WF, Glick L, et al. A prospective, randomized pilot trial of perfluorocarbon-induced lung growth in newborns with congenital diaphragmatic hernia. J Pediatr Surg 2003; 38:283.
- Kacmarek RM, Wiedemann HP, Lavin PT, et al. Partial liquid ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 2006; 173:882.
- Kaushal A, McDonnell CG, Davies MW. Partial liquid ventilation for the prevention of mortality and morbidity in paediatric acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev 2013; :CD003845.
- Galvin IM, Steel A, Pinto R, et al. Partial liquid ventilation for preventing death and morbidity in adults with acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev 2013; :CD003707.
- Lemaire F. Low-dose perfluorocarbon: a revival for partial liquid ventilation? Crit Care Med 2007; 35:662.
- Ricard JD, Iserin F, Dreyfuss D, Saumon G. Perflubron dosing affects ventilator-induced lung injury in rats with previous lung injury. Crit Care Med 2007; 35:561.
- Davies MW, Dunster KR, Wilson K, Colditz PB. Effect of the dose volume of perfluorocarbon when starting partial liquid ventilation. J Paediatr Child Health 2010; 46:714.