Liquid ventilation

T. H. Shaffer, Partial liquid ventilation in critically ill infants receiving extracorporeal life support. Philadelphia Liquid Ventilation Consortium, Pediatrics 99 (1997) E2. 

M.Q. Huang, Q. Ye, D.S. Williams, C. Ho, MRI of lungs using partial liquid ventilation with water-in-perfluorocarbon emulsions, Magn. Reson. Med. 48 (2002) 487-492. 

In different medical disciplines, highly fluorinated liquids are directly used, like in the case of ocular endotamponades in ophthalmology, of gas carriers in liquid ventilation, or of preservation and transport media in transplantation medicine. For these applications, the highly fluorinated liquids are used in a purified form or as mixtures. The extraordinary... 

This chapter presents the state of the art of the use of highly fluorinated liquids in ophthalmology and perspectives of future applications in the eye. In different medical disciplines, the characteristics of these fluids are directly used, like in the case of ocular endotamponades in ophthalmology, of gas carriers in liquid ventilation, or of preservation and transport media in transplantation medicine [1-3]. For these applications, the highly fluorinated liquids are used in a purified form or as mixtures. The intended effect is created by the physicochemical characteristics themselves. The extraordinary behaviour of the fluorocarbon liquids (FCLs) requires specialised biocompatibility testing, adjusted to this class of components. 

At the end of the 70s of the last century, an impressive experiment was controversially discussed a living mouse was completely submersed in a PFCL and could survive. This drastic demonstration of the efficacy of artificial respiration, and the tolerance to the substance used, is completely controversial. On the other hand, this test has become a milestone in the development of different medical applications of PFCLs. Not only the possibility of respiration from PFCL (liquid ventilation [3]) was proven, it could be demonstrated simultaneously that these PFCLs were tolerated by the skin and even by the eye and no toxic side effects were observed. 

The demonstration of the potential of this stable and obviously excellently tolerated compound has inspired a great number of scientists to develop PFCLs as special tools for medical applications and to introduce therapies using the outstanding behaviours of PFCLs, like the well-known concepts of complete and partial liquid ventilation [4], oxygen support of the skin, wound treatment [5], artificial tears [6], and ocular endotamponade media [1], to name only a few. Until now, the mouse submersed in PFCLs is often used as an eye-catcher for the demonstration of the biocompatibility of PFCLs even in cases where the topic of the presentation is not reflected by this experiment. 

T.H. Shaffer, D. Rubenstein, D. Moskowitz, M. Delivoria-Papadopoulos, Gaseous exchange and acid-base balance in premature lambs during liquid ventilation since birth, Pediatr. Res. 10 (1976) 227-231. 

C.L. Leach, J.S. Greenspan, D. Rubenstein, T.H. Shaffer, M.R. Wolfson, J.C. Jackson, R. DeLemos, B.P. Fuhrman, Partial liquid ventilation with perflubron in premature infants with severe respiratory distress syndrome. New Engl. J. Med. 335 (1996) 761-766. 

R.B. Hirschl, M. Croce, D. Gore, H. Wiedemann, K. Davis, R.H. Bartlett, Prospective, randomized, controlled pilot study of partial liquid ventilation in adult acute respiratory distress syndrome. Am. J. Respir. Crit. Care Med. 165 (2002) 781-787. 

J.P. Meinhardt, U. Friess, H.J. Bender, R.B. Hirschl, M. Quintel, Relationship among cardiac index, inspiration/expiration ratio, and perfluorocarbon dose during partial liquid ventilation in an oleic acid model of acute lung injury in sheep, J. Pediatr. Surg. 40 (2005) 1395-1403. 

A.T. Rotta, B. Gunnarsson, L.J. Hernan, B.P. Fuhrman, D.M. Steinhorn, Partial liquid ventilation with perflubron attenuates in vivo oxidative damage to proteins and lipids, Crit. Care Med. 28 (2000) 202-208. 

U. Merz, B. Klosterhalfen, M. Hausler, M. Kellinghaus, T. Peschgens, H. Homchen, Partial liquid ventilation reduces release of leukotriene B4 and interleukin-6 in bronch-oalveolar lavage in surfactant-depleted newborn pigs, Pediatr. Res. 51 (2002) 183-189. 

M. Gama de Abreu, A.D. Quelhas, P. Spieth, G. Brauer, L. Knels, M. Kasper, A.V. Pino, J.U. Bleyl, M. Hubler, F. Bozza, J. Salluh, E. Kuhlisch, A. Giannella-Neto, T. Koch, Comparative effects of vaporized perfluorohexane and partial liquid ventilation in oleic acid-induced lung injury, Anesthesiology 104 (2006) 278-289. 

Use perfluorocarbon as a web-search keyword and you willfind references, most of them technical, to a variety of medical and other uses for liquidperfiuorocarbons. The site listed here is that of the Liquid Ventilation Program at the University of Michigan. Scroll to the bottom of the home pagefor a list of useful links. 

Severe poisoning with modified-release verapamil was associated with respiratory failure in a 27-year-old man, who presented 2 hours after taking 24 g, one of the largest reported overdoses (24). He snrvived after receiving 4 days of partial liquid ventilation as a part of his medical management. 

Greenspan JS, WoRson MR, Shaffer TH. Liquid ventilation. Semin Peri-natol 2000 24 396-405. 

Corno et al. (2004) have developed a model for the liquid ventilation of neonates. The objective of this model was to properly specify ventilation parameters (breathing rate, tidal volume, inspiratory-to-expiratory time ratio, flow waveforms, PEC oxygen content, etc.) to add adequate oxygen to the blood and remove carbon dioxide. 

Como, C., G. B. Fiore, and M. L. Costantino, 2004, A mathematical model of neonatal tidal liquid ventilation integrating airway mechanics and gas transfer phenomena, IEEE Trans. Biomed. Eng. 51 604—611. 

There is little doubt that fertility- and productivity-affecting features of soils, such as liquid and electrolyte household management, i.e. the capacity to take up, hold, and pass liquids, ventilation, sorptional capacity, and the transport of dissolved substances, are highly dependent upon the structure and permeability of soil component colloid aggregates [1, 2]. Accordingly, the structure and permeability of mineral component clays are important factors [3]. 

Special precautions include the use of protective clothing, including eye or face protection and heavy leather gloves. Transfer operatioits, especially ttiose involving open containers such as Dewars, should be carried out slowly and carefully to control boiling and splashing of the liquid. Ventilation must be adequate to handle any gas evolved. 

Euhrman BP. Perfluorocarbon liquid ventilation the first human trial. J Pediatr 1990 117(part 1 of 2) 73-74. 

Greenspan JS. Liquid ventilation Physiology and potential neonatal applications. Proceedings of the 7th Annual Meeting of the National Association of Neonatal Nurses. New York National Association of Neonatal Nurses, 1991. 

The high solubility of respiratory gases allows the use of fluorocarbons for liquid ventilation and drug delivery by the pulmonary route [178]. For administration of drugs via the pulmonary route, reverse water in fluorocarbon emulsions... 

Shaffer TH, Wolfson MR, Clark LC. Liquid ventilation. Pediatr Pulmonol 1992 14 102-109. 

Colton DM, Till GO, Johnson KJ, Dean SB, Bartlett RH, Hirschl RB. Neutrophil accumulation is reduced during partial liquid ventilation. Crit Care Med 1998 26 1716-1724. 

Croce MA, Fabian TC, Patton JH, Melton SM, Moore M, Trenthem LL. Partial liquid ventilation decreases the inflammatory response in the alveolar environment of trauma patients. J Trauma Injury Infect Crit Care 1998 45 273-282. 

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