TreatmentofAcuteAsthmaintheICUwithLiquidPerfluorocarbon&CO2 GasCombinationBenjaminT.Wierstra1,2,FrancisH.Green1,3,4 ,JohnDennis4andJasonE.Waechter1
1DepartmentofCriticalCareMedicine,UniversityofCalgary;2DepartmentofNationalDefense,CanadianForcesHealthServices3SnyderInstituteforChronicDiseases,UniversityofCalgary;4SolAeroMedInc,Calgary,Alberta,Canada
ClinicalOutcome
EffectsofPerflubron&CO2 onTidalVolume(Day16)
Background
Perflubron&CO2
• Perflubron&CO2 aresafeandhavebeenseparatelyapprovedforuse2,3• Perflubroninstilled20mlintoeachofRUL,RML,RLL,LL&LLL(100mltotal)• 10%CO2 wasthenadministeredtosamesegmentsflowrate7-10L/minx5min
• Potentbronchodilator• Increaseselasticrecoil• Reducesgastrapping• Improvesperipheraloxygenation
• Medicalgradeperfluorocarbon• Syntheticsurfactant• Mucolytic• Gascarrier
Conclusion&FutureDirections
References1. CentersforDiseaseControlandPrevention.2018.
https://www.cdc.gov/asthma/most_recent_data.htm;Accessed16Feb2018.2. HealthCanada.MedicalDeviceLicence #79472[Perfluorocarbonbronchiallavage
solutions].DeviceIDNo532243;2009.3. HealthCanada.CarbonDioxide,CompressedAirMedicalG.Mix,AIGNo.0221194001.
1993.
PatientProfile� 38y♂ mixedrespiratoryfailure� Historyofasthma,exposuretoallergens,non-compliantwithasthmatherapies� Failedconventionalmechanicalventilation� Veno-veno extracorporealoxygenationinitiatedDay3,weanedDay8� SalinelavageonDay6failedtoremovemucousplugsorimprovepulmonarymechanics(seefigure)
� ExtubatedDay14&subsequentrepeatrespiratoryfailurepromptingrepeatv-vECMODay14,weanedDay17
0
1
2
3
4
5
6
7
8
9
10
02468
101214161820222426
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Percent
Totaln
umbe
rofp
ersonsin
millions
AsthmaPrevalence:UnitedStates,2001-20101
AdmissionCXR– Day0 Pre-perflubronCXR– Day16
+Perflubron CO2
ImmediatelyPost-Perflubron
CXRDay16
Post-extubation CXRPost-Perflubron
Day26
EffectofSalineLavageonTidalVolume(Day6)• 26millionAmericanslivewithAsthma(7.8%population)1• Asthmakills3,400 Americanadults/yr (13.7permillion)1• Refractorystatusasthmacontinuestobeaclinicalchallenge
• LiberatedfromV-VECMOafter3days
• Extubated7dayslater
• CoursecomplicatedbyprofoundcriticalIllnessneuropathy/myopathy
• Attendingrehabilitation
• Perflubron&CO2 administrationproducedarapid&sustainedimprovementinpulmonarymechanicsinacaseofrefractorysevereasthmarequiringintensivecaresupport
• Thisnoveltreatmentcombinesthemucolytic&surfactantpropertiesofPerflubronwiththebronchodilatory effectsofCO2
• FacilitatedliberationfromV-VECMO
• Furtherresearchanddescriptionsofthephysiologiceffectsrequired
Informedconsentwasobtainedforthistreatmentfromthefamilyofthepatient.Thepatientconsentedtopublicationofthiscasereport.SolAeroMedInc.,providedthemedicalgradeperflubronandCO2 gas.FHGandJDareshareholdersandboardmembersofSolAeroMedInc.withthepatentrightsforthistreatment.BTWandJWhavenoconflictsofinteresttodeclare.
SpontaneousTidalVolumes
RespiratoryRate
100200300400500Vt
1015
5
RR
1100 12001000 1300 1400Time
SalineBronchoscopicLavage
SpontaneousTidalVolumes
RespiratoryRate
1015
5
RR20
100200300400500Vt600700800
1500 16001400 1700 1800Time
Perflubron&CO2BronchoscopicLavage
Consent&Disclosures
