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Partial liquid breathing: are we headed in the right direction?

The notion that perfluorochemical compounds might help support gas exchange was first introduced in 1966 (1). Perfluorochemicals have been examined as blood substitutes, as intravenous and oral contrast agents, and as vehicles to enhance intrapulmonary drug delivery including surfactant. Perfluorocarbons also have been shown to have potent anti-inflammatory properties (2, 3), although the precise mechanism by which these drugs interrupt the inflammatory cascade has yet to be elucidated. A recent literature search utilizing the keyword "perfluorocarbon" yielded over 600 references. Twenty-five of those publications appeared in Critical Care Medicine beginning with the first description of partial liquid breathing by Fuhrman et al. in 1991 (4). Almost 300 humans have been treated with one perfluorochemical compound (perfluorooctylbromide or perflubron) as part of uncontrolled industry and investigatorsponsored phase 1 trials as well as industry and investigator-sponsored randomized controlled trials. Presently, no perfluorocarbon compounds are approved for human use, and one drug (perflubron) is currently being examined in an ongoing human trial involving adults with acute lung injury.