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Volume 335:761-767 September 12, 1996 Number 11 Next

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ABSTRACT

Background The intratracheal administration of a perfluorocarbon liquid during continuous positive-pressure ventilation (partial liquid ventilation) improves lung function in animals with surfactant deficiency. Whether partial liquid ventilation is effective in the treatment of infants with severe respiratory distress syndrome is not known.

Methods We studied the efficacy of partial liquid ventilation with perflubron in 13 premature infants with severe respiratory distress syndrome in whom conventional treatment, including surfactant therapy, had failed. Partial liquid ventilation was initiated by instilling perflubron during conventional mechanical ventilation to a volume approximating the functional residual capacity. Infants were considered to have completed the study if they received partial liquid ventilation for at least 24 hours.

Results Ten infants received partial liquid ventilation for 24 to 76 hours. In the other three infants, partial liquid ventilation was discontinued within four hours in favor of high-frequency ventilation, which was not permitted by the protocol, and the data from these infants were excluded from the analysis. Within one hour after the instillation of perflubron, the arterial oxygen tension increased by 138 percent and the dynamic compliance increased by 61 percent; the mean (±SD) oxygenation index was reduced from 49±60 to 17±16. Chest radiographs showed symmetric filling, with patchy clearing during the return from partial liquid to gas ventilation. There were no adverse events clearly attributable to partial liquid ventilation. Infants were weaned from partial liquid to gas ventilation without complications. Eight infants survived to 36 weeks' corrected gestational age.

Conclusions Partial liquid ventilation leads to clinical improvement and survival in some infants with severe respiratory distress syndrome who are not predicted to survive.

Source Information

From the Department of Pediatrics, State University of New York at Buffalo and Children's Hospital of Buffalo, Buffalo (C.L.L., B.P.F.); the Department of Pediatrics, Jefferson Medical College, Philadelphia (J.S.G.); the Departments of Pediatrics and Physiology, Temple University School of Medicine and St. Christopher's Hospital for Children, Philadelphia (S.D.R., T.H.S., M.R.W.); the Department of Pediatrics, University of Washington and Children's Hospital and Medical Center, Seattle (J.C.J.); and the Department of Pediatrics, University of Southern California Medical Center, Los Angeles (R.D.).

Address reprint requests to Dr. Leach at the Division of Neonatology, Children's Hospital of Buffalo, 219 Bryant St., Buffalo, NY 14222.

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Perflubron in Infants with Severe Respiratory Distress Syndrome
Salon J. E., Leach C. L., Fuhrman B. P., Shaffer T. H.
Extract | Full Text  
N Engl J Med 1997; 336:660, Feb 27, 1997. Correspondence

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