The Pulmonary and Systemic Distribution and Elimination of Perflubron From Adult Patients Treated With Partial Liquid Ventilation

摘要

Objective: To assess the pulmonary and systemic distribution and elimination of perflubronn(C8F17Br1; LiquiVent; Alliance Pharmaceutical; San Diego, CA) during and following the periodnof partial liquid ventilation.nDesign: Prospective phase I and II clinical trial.nSetting: Adult surgical ICU.nPatients: Eighteen adult patients (mean 6 SEM age, 37.9 6 3.4 years) with severe respiratory failure,nsome of whom required extracorporeal life support (72%), and who were managed with partial liquidnventilation with perflubron.nInterventions: Perflubron was administered into the trachea, and gas ventilation of the perfluorocar-nbon-filled lung (partial liquid ventilation) was then performed. Additional doses were administeredndaily for from 1 to 7 days, with a median cumulative dose of 31 mL/kg (range, 3 to 60 mL/kg).nMeasurements and main results: Patient blood samples were evaluated by gas chromatography for serumnperflubron levels. Sequential lateral and anteroposterior radiographs were assessed, using a 5-point ratingnscale, for the degree of perflubron fill following the final dose. Samples of expired gas were collected, andnthe rate of loss of perflubron in the expired gas was measured by gas chromatography. Mean serumnperflubron levels increased to 0.1660.05 mg/dL at 24 h following administration of the initial dose. Anmean maximum level of 0.2660.05 mg/dL of perflubron was present in the serum 24 h following thenadministration of the last dose. This level slowly trended downward to 0.1860.06mg/dL over the ensuingn7 days (p50.281). Perflubron elimination via expired gas occurred at amean rate of 9.463.0mL/h at 1 h,nand 1.060.4 mL/h at 48 h after the last dose (p50.012). By radiologic evaluation, perflubron wasneliminated from the lungs progressively from 4.260.2 at the time of administration of the last dose, ton2.860.3 at 4 days later (p<0.001). Perflubron tended to distribute and remain for longer periods in thendependent regions of the lung when compared to the nondependent regions (96-h perflubron fill score:nposterior, 3.860.5; anterior, 1.960.4; p50.004).nConclusions: Perflubron is eliminated at a maximum rate of 9.463.0 mL/h by evaporative loss from thenairways and is retained in greater amounts in the dependent lung regions when compared to thennondependent lung regions. There is a low but measurable maximum blood concentration of 0.2660.05nmg/dL in patients after perflubron administration, which did not decrease significantly after cessation ofnpartial liquid ventilation. (CHEST 2001; 119:515–522)