The use of partial liquid ventilation to decrease the number of deaths and illness in children with acute onset respiratory failure is not supported by evidence from randomized controlled trials.
Severely ill children can develop lung disease, called acute lung injury or acute respiratory distress syndrome, which stops sufficient oxygenation of the blood. The children are treated with mechanical ventilation through a tube placed in the airway. This improves lung function and the supply of oxygen to the body but it can also lead to ventilator-induced lung injury. Children who survive an episode of this severe lung disease often have long-term illness including decreased lung function, impaired cognitive function, poor neurodevelopmental progress, and high rates of permanent disability.
Partial liquid ventilation could be a less injurious form of respiratory support. A special liquid (perfluorocarbon liquid) is poured into the lungs to partly replace the gas in normally gas-filled lungs, and mechanical ventilation is continued with a gas ventilator.
The review authors found only one multicentre randomized controlled study, reported as an abstract in conference proceedings, that was eligible for inclusion in the review. The company sponsored study enrolled 182 patients in 65 centres. The trial was stopped early, before recruiting sufficient numbers of participants and before it could detect any clear differences between partial liquid ventilation and conventional mechanical ventilation (the control group). The number of deaths at 28 days was 22% of patients in the partial liquid ventilation group and 14% in the control group, the difference was not statistically significant; there was a wide variation in results and a clinically significant difference could not be excluded. There were other problems with the trial that made its results unreliable in terms of eligible patients, use of other rescue therapies, and that the measured outcomes were altered at least twice during the study; additional therapies such as high frequency ventilation or inhaled nitric oxide were allowed in the control group.