British Journal of Anaesthesia, 2003, Vol. 91, No. 1 143-151
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia
Review Article |
Liquid ventilation
1 Klinik für Anästhesiologie und Intensivmedizin, Charité-Campus Virchow-Klinikum, Med. Fakultät der Humboldt Universität zu Berlin, Berlin, Germany. 2 Department of Anaesthesia, Critical Care and Pain Medicine, Western General Hospital,Crewe Road, Edinburgh EH4 2XU, Scotland |
Corresponding author. E-mail: Keith.Kelly@ed.ac.uk
Keywords: complications, acute respiratory distress syndrome; pharmacology, perfluorocarbons; ventilation, liquid
| The first 150 words of the full text of this article appear below. |
For 350 million years, fish have breathed liquid through gills. Mammals evolved lungs to breathe air. Rarely, circumstances can occur when a mammal needs to ‘turn back the clock’ to breathe through a special liquid medium. This is particularly true if surface tension at the air–liquid interface of the lung is increased, as in acute lung injury. In this condition, surface tension increases because the pulmonary surfactant system is damaged, causing alveolar collapse, atelectasis, increased right-to-left shunt and hypoxaemia.69 The aims of treatment are: (i) to offset increased forces causing lung collapse by applying mechanical ventilation with PEEP; (ii) to decrease alveolar surface tension with exogenous surfactant; (iii) to eliminate the air–liquid interface by filling the lung with a fluid in which both oxygen and carbon dioxide are highly soluble to serve as a respiratory medium.
This third concept, liquid ventilation, recalls the early work of von Neergaard, who showed
History of breathing a liquid medium
PFCs as a respiratory medium
Liquid ventilation with PFCs
Liquid ventilation in normal lungs
Early liquid ventilation with PFCs in humans
Possible benefits of liquid ventilation in acute lung injury (see Fig. 3)
Properties required for a PFC for liquid ventilation
Mechanisms of liquid ventilation with PFCs
Improvement in oxygenation
Improved lung compliance
Differences in dose requirement to improve oxygenation and improve lung mechanics
Adjuncts to PLV
Anti-inflammatory properties of PFCs
Pulmonary drug delivery by PFCs
Further human studies of PLV
Adverse effects of liquid ventilation (see Fig. 3)
Pneumothorax
Circulatory impairment
Lactic acidosis
Weaning from PLV and resuming conventional gas ventilation
Blocking of the tracheal tube
Carbon dioxide clearance
Elimination and toxicity
Interference with radiographic imaging
PFCs given by vapour or aerosol
Conclusion
Acknowledgement
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