(1163) Use of Partial Liquid Ventilation as an Adjunct for Rescue of Severe ARDS: A Case Series

Introduction: Partial Liquid Ventilation (PLV) has unique properties (high density yet low surface tension, high gas solubility and anti-inflammatory properties) that potentially make it a tool in the Intensivists tool-kit for rescue of refractory ARDS. Although not FDA approved in the US, Perflubron is available for investigational use and we describe its outcomes in three adult patients referred for ECLS.

Description: 1) 18 year-old woman with Hemoglobin S-S developed Acute Chest Syndrome along with aplastic crisis at an OSH. She was placed on V-V ECMO immediately on arrival when in extremis from severe hypoxemia on day 7 of MV. She also had secondary Pseudomonas VAP and fungemia revealed 1 day after cannulation. We used PLV at a dose of 10ml/kg of IBW with improvement of her lung aeration and clearance of bronchial debris. Unfortunately, she died when ECMO was withdrawn due to progressive multiorgan failure from septic shock.
2) 52 year-old man with RA on chronic steroids and methotrexate was transferred from an OSH for ECLS evaluation due to severe hypoxemia (P/F 51) and hypercarbia (pCO2 78) on ARDSnet MV strategy with paralytics. He had rapid improvement in gas exchange s/p placed on APRV and subsequently had PLV performed twice which rapidly cleared his thick purulent secretions allowing lung recruitment. He was weaned from MV and D/C home on RA on day 28.
3) 27 year-old man with COVID-19 ARDS and MSSA VAP was referred for ECLS on day10 of MV when in extremis due to severe hypoxemia on ARDSnet strategy with paralytics and proning, so was placed on V-V ECMO immediately. We performed PLV at 10ml/kg to assist in clearance of necrotic lung and recruitment of collapsed lung while on APRV. He eventually weaned from ECMO and then from MV and was D/C walking to his car on day 172.

Discussion: Severe ARDS has a high mortality despite current recommendations and sometimes other adjuncts and strategies are needed to be considered. PLV may be a useful tool in the appropriate clinical situation.