Liquid ventilation.

In laboratory models, PLV is clearly more effective than conventional ventilation alone; however, this advantage has not been observed in any human study. The reasons for this are unclear, but the approach to ventilation during PLV may have been inappropriate. HFO may require further study or perhaps PLV should be combined with nitric oxide or some other vasoactive agent. Additionally, perfluorocarbons may need to be aerosolized instead of instilled. Kandler et al. recently demonstrated better gas exchange that was sustained for a longer period in lavage-injured piglets when a perfluorocarbon was aerosolized. This preliminary result demonstrates that there are other options for the delivery of perfluorocarbons in the management of critically ill patients. Based on the failure of the two trials in adult ARDS patients, however, a long time may pass before another human PLV trial is undertaken.