ObjectiveLiquid ventilation with perfluorocarbon previously has not been reported in pediatric patients with respiratory failure beyond the neonatal period. We evaluated the technique of partial liquid ventilation in six pediatric patients with the acute respiratory distress syndrome of sufficient severity to require extracorporeal life support (ECLS).DesignThis study was a noncontrolled, phase I/II experimental study with a single group pretest/posttest design.SettingAll studies were performed at a tertiary, pediatric referral hospital at the University of Michigan Medical School.PatientsSix pediatric patients, from 8 wks to 5 1/2 yrs of age, with severe respiratory failure requiring ECLS to support gas exchange.InterventionsAfter 2 to 9 days on ECLS, perfluorocarbon was administered into the trachea until the dependent zone of each lung was filled. The initial dose administered was 12.9 plus minus 2.3 mL/kg (range 5 to 20). Gas ventilation of the perfluorocarbon-filled lungs (partial liquid ventilation) was then performed. The perfluorocarbon dose was repeated daily for a total of 3 to 7 days, with a cumulative dose of 45.2 plus minus 6.1 mL/kg (range 30 to 72.5).Measurements and Main ResultsAll measurements of native gas exchange were made during brief periods of discontinuation of ECLS and include PaO2and the alveolar-arterial oxygen gradient, P(A-a)O2. Static pulmonary compliance, corrected for weight, was also measured directly.The mean PaO sub 2 increased from 39 plus minus 6 to 92 plus minus 29 torr (5.2 plus minus 0.8 to 12.2 plus minus 3.9 kPa) over the 96 hrs after the initial dose (p equals .021 by repeated-measures analysis of variance). The average P(A-a)O sub 2 decreased from 635 plus minus 10 to 499 plus minus 77 torr (84.7 plus minus 1.3 to 66.5 plus minus 10.3 kPa) over the same time period (p equals .059), while the mean static pulmonary compliance (normalized for patient weight) increased from 0.12 plus minus 0.02 to 0.28 plus minus 0.08 mL/cm H2O/kg (p equals .01). All six patients survived. Complications potentially associated with partial liquid ventilation were limited to pneumothoraces in two of six patients.ConclusionsPerfluorocarbon may be safely administered into the lungs of pediatric patients with severe respiratory failure on ECLS and may be associated with improvement in gas exchange and pulmonary compliance.(Crit Care Med 1996; 24:16-22)