There is no evidence from randomized controlled trials to support or refute the use of partial liquid ventilation in adults with severe lung disease

Davies MW, Fraser JF

Published Online:

January 21, 2009

Severely ill adults can get severe lung disease that stops enough oxygen getting into the blood: this is called acute lung injury or acute respiratory distress syndrome. About half of these patients die. To try and improve the situation a special liquid (perfluorocarbon) is introduced into the lungs to partly replace the gas in normally gas-filled lungs: this is called partial liquid ventilation (PLV). PLV allows the use of lower pressures and volumes delivered by the mechanical ventilator: increasing the amount of oxygen in the blood whilst causing less damage to the lung. Only one trial has been reported on PLV in adults and this does not provide enough evidence to support its use.

Abstract (click to read)

Background:

Acute lung injury (ALI), and acute respiratory distress syndrome (ARDS), are syndromes of severe respiratory failure. Adults with ALI or ARDS have high mortality and significant morbidity. Partial liquid ventilation (PLV) may be better (i.e., cause less lung damage) for these patients than other forms of respiratory support. Uncontrolled studies in adults have shown improvement in gas exchange and lung compliance with partial liquid ventilation.

Objectives:

To assess whether partial liquid ventilation reduces morbidity and mortality in adults with ALI or ARDS.

Search strategy:

We searched The Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library Issue 2, 2004; MEDLINE (1966 to May 2004); and CINAHL (1982 to May 2004); intensive care journals and conference proceedings; reference lists and unpublished literature.

Selection criteria:

Randomized controlled trials which compared partial liquid ventilation with other forms of ventilation, in adults (16 years old or greater) with ALI or ARDS, reporting one or more of the following: mortality; duration of mechanical ventilation, respiratory support, oxygen therapy, stay in the intensive care unit, or stay in hospital; infection; long term cognitive impairment or health related quality of life; long term lung function; or cost.

Data collection and analysis:

Two reviewers independently evaluated the quality of the relevant studies and extracted the data from the included studies.

Main results:

Problems with the inadequacy of the primary report of the one included study do not allow us to report any quantitative results for patients with ALI or ARDS. The only outcome we considered to be of clinical significance and reported for all enrolled patients (i.e., patients with ALI and ARDS and less severe respiratory insufficiency) was 28 day mortality. There was no statistically significant difference between groups for this outcome with a relative risk for 28 day mortality in the PLV group of 1.15 (95% confidence intervals of 0.64 to 2.10).

Authors' conclusions:

There is no evidence from randomized controlled trials to support or refute the use of partial liquid ventilation in adults with ALI or ARDS; adequately powered, high quality randomized controlled trials are still needed to assess its efficacy. Clinically relevant outcome measures should be assessed (especially mortality at discharge and later, duration of respiratory support and hospital stay, and long term cognitive and quality of life outcomes) and the studies should be published in full.

This record should be cited as:

Davies MW, Fraser JF. Partial liquid ventilation for preventing death and morbidity in adults with acute lung injury and acute respiratory distress syndrome. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD003707. DOI: 10.1002/14651858.CD003707.pub2

Assessed as up to date:

August 25, 2004

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Primary Review Group:

Anaesthesia Group

Health topics:

Anaesthesia & pain control > Post-anaesthetic unit/intensive care unit > Respiratory care

Anaesthesia & pain control > Ventilation in peri-anaesthetic/critical care

Lungs & airways > Ventilation in peri-anaesthetic/critical care

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

There is no evidence from randomized controlled trials to support or refute the use of partial liquid ventilation in adults with severe lung disease

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