title: Partial liquid ventilation in adult patients with acute respiratory distress syndrome.
abstract: BACKGROUND
  Despite recent clinical trials demonstrating improved outcome in acute respiratory distress syndrome (ARDS), mortality remains high. Partial liquid ventilation (PLV) using perfluorocarbons has been shown to improve oxygenation and decrease lung injury in various animal models.
  
  
  OBJECTIVE
  To determine if PLV would have an impact on outcome in patients with ARDS.
  
  
  METHODS
  Patients with ARDS were randomized to (1) conventional mechanical ventilation (CMV; n=107), (2) "low-dose" perfluorocarbon (10 ml/kg; n=99), and (3) "high-dose" perfluorocarbon (20 ml/kg; n=105). Patients in all three groups were ventilated using volume ventilation, Vt <or= 10 ml/kg predicted body weight, rate <or= 25/min, inspiratory-to-expiratory ratio <or= 1:1, Fi(O(2)) >or= 0.5, and positive end-expiratory pressure >or= 13 cm H(2)O.
  
  
  RESULTS
  The 28-d mortality in the CMV group was 15%, versus 26.3% in the low-dose (p=0.06) and 19.1% in the high-dose (p=0.39) PLV groups. There were more ventilator-free days in the CMV group (13.0+/-9.3) compared with both the low-dose (7.4+/-8.5; p<0.001) and high-dose (9.9+/-9.1; p=0.043) groups. There were more pneumothoraces, hypoxic episodes, and hypotensive episodes in the PLV patients.
  
  
  CONCLUSIONS
  PLV at both high and low doses did not improve outcome in ARDS compared with CMV and cannot be recommended for patients with ARDS.
authors.affiliation: Department of Anesthesia and Critical Care, Harvard Medical School, and Respiratory Care, Massachusetts General Hospital, Boston, MA 02114, USA. rkacmarek@partners.org
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kacmarek
authors.forename: Herbert P
authors.initials: HP
authors.lastname: Wiedemann
authors.forename: Philip T
authors.initials: PT
authors.lastname: Lavin
authors.forename: Mark K
authors.initials: MK
authors.lastname: Wedel
authors.forename: Ahmet S
authors.initials: AS
authors.lastname: Tütüncü
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Slutsky
mesh_terms: D004305:Dose-Response Relationship, Drug; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007322:Instillation, Drug; D021061:Liquid Ventilation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012128:Respiratory Distress Syndrome / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D005466:Fluorocarbons