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  • Treatment of Acute Asthma in the ICU with Liquid … · 2018. 6. 27. · Treatment of Acute Asthma in the ICU with Liquid Perfluorocarbon & CO 2Gas Combination Benjamin T. Wierstra1,2,
1
Treatment of Acute Asthma in the ICU with Liquid Perfluorocarbon & CO 2 Gas Combination Benjamin T. Wierstra 1,2 , Francis H. Green 1,3,4 , John Dennis 4 and Jason E. Waechter 1 1 Department of Critical Care Medicine, University of Calgary; 2 Department of National Defense, Canadian Forces Health Services 3 Snyder Institute for Chronic Diseases, University of Calgary; 4 SolAeroMed Inc, Calgary, Alberta, Canada Clinical Outcome Effects of Perflubron & CO 2 on Tidal Volume (Day 16) Background Perflubron & CO 2 • Perflubron & CO 2 are safe and have been separately approved for use 2,3 • Perflubron instilled 20ml into each of RUL, RML, RLL, LL & LLL (100ml total) • 10% CO 2 was then administered to same segments flow rate 7-10L/min x 5 min • Potent bronchodilator • Increases elastic recoil • Reduces gas trapping • Improves peripheral oxygenation • Medical grade perfluorocarbon • Synthetic surfactant • Mucolytic • Gas carrier Conclusion & Future Directions References 1. Centers for Disease Control and Prevention. 2018. https://www.cdc.gov/asthma/most_recent_data.htm; Accessed 16 Feb 2018. 2. Health Canada. Medical Device Licence # 79472 [Perfluorocarbon bronchial lavage solutions]. Device ID No 532243; 2009. 3. Health Canada. Carbon Dioxide, Compressed Air Medical G.Mix, AIG No. 0221194001. 1993. Patient Profile 38y ♂ mixed respiratory failure History of asthma, exposure to allergens, non-compliant with asthma therapies Failed conventional mechanical ventilation Veno-veno extracorporeal oxygenation initiated Day 3, weaned Day 8 Saline lavage on Day 6 failed to remove mucous plugs or improve pulmonary mechanics (see figure) Extubated Day 14 & subsequent repeat respiratory failure prompting repeat v-v ECMO Day 14, weaned Day 17 0 1 2 3 4 5 6 7 8 9 10 0 2 4 6 8 10 12 14 16 18 20 22 24 26 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Percent Total number of persons in millions Asthma Prevalence: United States, 2001-2010 1 Admission CXR – Day 0 Pre-perflubron CXR – Day 16 + Perflubron CO 2 Immediately Post-Perflubron CXR Day 16 Post-extubation CXR Post-Perflubron Day 26 Effect of Saline Lavage on Tidal Volume (Day 6) • 26 million Americans live with Asthma (7.8% population) 1 • Asthma kills 3,400 American adults/yr (13.7 per million) 1 • Refractory status asthma continues to be a clinical challenge • Liberated from V-V ECMO after 3 days • Extubated 7 days later • Course complicated by profound critical Illness neuropathy/myopathy • Attending rehabilitation • Perflubron & CO 2 administration produced a rapid & sustained improvement in pulmonary mechanics in a case of refractory severe asthma requiring intensive care support • This novel treatment combines the mucolytic & surfactant properties of Perflubron with the bronchodilatory effects of CO 2 • Facilitated liberation from V-V ECMO • Further research and descriptions of the physiologic effects required Informed consent was obtained for this treatment from the family of the patient. The patient consented to publication of this case report. SolAeroMed Inc., provided the medical grade perflubron and CO 2 gas. FHG and JD are shareholders and board members of SolAeroMed Inc. with the patent rights for this treatment. BTW and JW have no conflicts of interest to declare. Spontaneous Tidal Volumes Respiratory Rate 100 200 300 400 500 V t 10 15 5 RR 1100 1200 1000 1300 1400 Time Saline Bronchoscopic Lavage Spontaneous Tidal Volumes Respiratory Rate 10 15 5 RR 20 100 200 300 400 500 V t 600 700 800 1500 1600 1400 1700 1800 Time Perflubron & CO 2 Bronchoscopic Lavage Consent & Disclosures

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Page 1: Treatment of Acute Asthma in the ICU with Liquid … · 2018. 6. 27. · Treatment of Acute Asthma in the ICU with Liquid Perfluorocarbon & CO 2Gas Combination Benjamin T. Wierstra1,2,

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

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