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Special Feature: Oral Presentations

HISTORY OF LIQUID VENTILATION

Shaffer, Thomas H.

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The respiratory system of a newborn infant is a complex organ system that interfaces the neonate with its new gaseous environment. The efficiency of the lungs as an exchanger for oxygen and carbon dioxide is essential for proper transition from the fetal to extrauterine environment. This presentation discusses the theoretical concepts, experimental evidence, and initial clinical results which support the use of perfluorochemical (PFC) liquid ventilation as a ventilation strategy for treating neonates with respiratory distress.

As presented herein, PFC liquids have great potential for biomedical use and the support of respiration. Currently, there are several commercially available PFC fluids which meet the physicochemical property requirements as well as purity specifications necessary to perform many of the discussed biomedical applications. Moreover, state-of-the-art fluorine chemistry should enable production of new PFC liquids uniquely sculptured relative to the proposed specific application (i.e., a vehicle for pulmonary delivery of drugs, a diluent for pulmonary lavage, a medium for respiratory gas exchange).

In addition to PFC fluid requirements, there have been several techniques reported for liquid assisted ventilation. These methods include total liquid ventilation, (TLV), liquid lavage, drug delivery, partial liquid ventilation, (PLV), and aerosol approaches. The efficacy of these various techniques is under extensive investigation with respect to specific types of lung disfunction. In addition, current laboratory studies are focused on documenting possible advantages over existing conventional therapies as well as identifying the relative utility of individual techniques. In addition, perfluorochemicals have been used for non-respiratory applications, such as blood substitutes, limaging, cryosurgery, lung growth, and induction of hypothermia.

Finally, liquid ventilation techniques have the potential to treat lung disease with less risk of barotrauma and provide the means for direct and uniform delivery of pulmonary agents to injured or disfunctional sites in the lung. For liquid ventilation to assume a role in clinical medicine, it must be shown to be safe and effective with respect to other therapies or in combination with current therapies. Although animal studies have been impressive to date, better documentation of efficacy in human disease studies will be required. Further controlled multi-center clinical trials are warranted.

References:

1. Shaffer TH: A Brief Review: Liquid Ventilation. Undersea Biomed Res 14: 169–178, 1987.
    2. Wolfson MR, Shaffer TH: Liquid Ventilation during early development: theory, physiologic processes, and application. J Dev Physiol 13: 1–12, 1990.
      3. Shaffer TH, Wolfson MR, Clark LC: State of art review: Liquid ventilation. Pediatr Pulmonol 14: 102–109, 1992.
        4. Wolfson MR, Shaffer TH: Liquid assisted ventilation: From concept to clinical application. Sem Neonatol 2: 115–127, 1997.
          5. Shaffer, TH, Wolfson MR: Liquid Ventilation. In Polin R, Fox WW, Abman S: Fetal and Neonatal Physiology, (Eds.), 3rd Edition, WB Saunders, Philadelphia, PA. 2003.
            6. Wolfson MR, Shaffer TH: Pulmonary applications of perflurorchemical liquids: Ventilation and beyond. Paedriat Respir Rev 6: 117–127, 2005.
              Copyright © 2006 by the American Society for Artificial Internal Organs