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Vol. 27, Art. 32 (pp. 746-776)    |    2026       

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Perfluorocarbons in the treatment of severe bronchopulmonary pathology. Part IV: bronchoalveolar lavage (analytical review)

Bonitenko E.U.,1,5 Belyakova N.A.,2 Burov A.A.,3 Bala A.V.4

1Federal State Budgetary Science Institution «Scentific institute of occupational medicine named after academician N.F. Izmerova»
105275, Moscow, pr. Budennogo, 31
2Federal State Budgetary Institution «Scientific and Clinical Center of Toxicology named after academician S.N. Golikov of the Federal Medical and Biological Agency
192019, Sankt-Peterburg, str. Behtereva, 1
3Federal State Budgetary Institution "National Medical Research Center of Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakov" of the Ministry of Health of Russia
117997, Moscow, st. Academician Oparin, 4
4Foundation for Advanced Studies, 121059, Moscow,
Berezhkovskaya nab., 22, bldg. 3,
5Federal State Unitary Enterprise "Research Institute of Hygiene, Occupational Pathology and Human Ecology" of the Federal Medical and Biological Agency,
188663, Leningrad Region, Vsevolozhsky District, Kuzmolovskoye Township, Zavodskaya Street, building. 6/2, bldg. 93

Brief summary

Acute broncho obstructive syndrome (ABOS) is one of the most severe manifestations of respiratory pathology and is characterized by distal airway obstruction, atelectasis, marked ventilation-perfusion mismatch, and acute respiratory failure. In cases where standard therapy and conventional saline bronchoalveolar lavage (BAL) fail to provide adequate sanitation of the lower airways, approaches combining removal of obstructive material with preservation of lung function become particularly relevant. One such approach is BAL with perfluorocarbons (PFCs). This review systematizes experimental and clinical data on the use of PFC BAL in severe ABOS in adults, children, and newborns. The key physicochemical properties of PFCs — high density, low surface tension, high solubility of respiratory gases, and chemical and biological inertness — are considered as the basis of a multicomponent mechanism of action, including mechanical evacuation of pathological material from distal airways, alveolar recruitment, partial maintenance of gas exchange, and improvement of respiratory mechanics. PFC BAL is shown to be an independent sanitation technology, distinct from partial liquid ventilation (PLV) in terms of therapeutic purpose, procedural characteristics, and clinical application. At present, the most convincing clinical evidence for PFC BAL relates to massive pulmonary hemorrhage with distal clot formation and prolonged atelectasis refractory to standard therapy in the setting of deep muco obstruction. In pulmonary alveolar proteinosis and other proteinosis like conditions, PFC based technologies appear to provide mainly functional support and may be regarded as an adjunct within combined treatment strategies rather than an alternative to whole lung saline lavage. At the same time, the pathophysiological rationale of the method suggests its potential relevance for other forms of severe ABOS, including acute pneumonias with pronounced distal muco obstruction and aspiration related lung injury, although clinical data for these scenarios remain limited. The current evidence base for PFC BAL is largely restricted to case reports and small case series; the technique remains non standardized and reported outcomes vary across centers. At this stage, PFC BAL should be regarded as a promising but highly specialized rescue approach for carefully selected patients with severe ABOS unresponsive to standard treatment. Further development of this field requires protocol standardization and systematic clinical studies to refine indications, limitations, and the balance between expected benefit and potential risks.


Key words

bronchoalveolar lavage; perfluorocarbons; acute respiratory failure; pulmonary hemorrhage; acute pneumonia

Reference list

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References


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2. Fahy J.V., Dickey B.F. Airway mucus function and dysfunction. N Engl J Med. 2010;363(23):2233-2247. doi:10.1056/NEJMra0910061.


3. Christenson S.A., Smith B.M., Bafadhel M. et al.. Chronic obstructive pulmonary disease. Lancet. 2022;399(10342):2227-2242. doi:10.1016/S0140-6736(22)00470-6


4. Karnik A.M., Medhat M., Farah S. Therapeutic use of bronchoalveolar lavage in a very difficult asthmatic: a case report. J Asthma. 1989;26(3):181-184. doi:10.3109/02770908909070988.


5. Khan M., Al Otair H.A., Elgishy A.F., et al. Bronchoscopy as a rescue therapy in patients with status asthmaticus: two case reports and review of literature. Saudi J Anaesth. 2013;7(3):327. doi:10.4103/1658-354x.115323.


6. Israel E., Reddel H.K. Severe and difficult-to-treat asthma in adults. N Engl J Med. 2017;377(10):965-976. doi:10.1056/NEJMra1608969


7. Whittaker Brown S.A., Braman S. Recent advances in the management of acute exacerbations of chronic obstructive pulmonary disease. Med Clin North Am. 2020;104(4):615-630. doi:10.1016/j.mcna.2020.02.003.


8. Moslehi M.A. Bronchoscopic surfactant administration in premature neonate with persistent lobar atelectasis: the new concept. J Matern Fetal Neonatal Med. 2019;34(19):3277-3279. doi:10.1080/14767058.2019.1680628.


9. Miyagi K., Haranaga S., Higa F., et al. Implementation of bronchoalveolar lavage using a high flow nasal cannula in five cases of acute respiratory failure. Respir Investig. 2014;52(5):310-314. doi:10.1016/j.resinv.2014.06.006.


10. Reiter K., Schober S., Schranz D., et al. Whole lung lavage in infants and children with pulmonary alveolar proteinosis. Pediatr Anesth. 2010;20(12):1118-1123. doi:10.1111/j.1460-9592.2010.03442.x.


11. Kaushal B., Chauhan S., Hasija S. Bilateral whole lung lavage by lung isolation in a child with pulmonary alveolar proteinosis. Ann Card Anaesth. 2021;24(2):266-268. doi:10.4103/aca.aca_90_19.


12. Cai C., Ye M., Xu H., Li Y. Pulmonary alveolar proteinosis treatment by whole lung lavage. Postgrad Med J. 2012;88(1042):492-493. doi:10.1136/postgradmedj 2011 130620.


13. Dargaville PA, Herting E, Soll RF. Neonatal surfactant therapy beyond respiratory distress syndrome. Semin Fetal Neonatal Med. 2023;28(6):101501. doi:10.1016/j.siny.2023.101501.


14. Guo H., Chen X., Hui H. et al. Pulmonary surfactant combined with budesonide in the treatment of neonatal respiratory distress syndrome. Transl Pediatr. 2023;12(6):1288-1289. doi: 10.21037/tp-23-30.


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16. Abdelaal M.A., Abushanab D., Al Badriyeh D. Surfactant therapy for meconium aspiration syndrome in neonates: a systematic overview of systematic reviews and recent clinical trials. J Comp Eff Res. 2020;9(8):527-536. doi:10.2217/cer-2020-0018


17. Teague W.G. Lung lavage inflammatory patterns and pathogen profiles in preschool children with problematic wheeze. Ann Allergy Asthma Immunol. 2022;129(6):674-675. doi:10.1016/j.anai.2022.07.001


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21. Shale D.J., Ionescu A.A. Mucus hypersecretion: a common symptom, a common mechanism? Eur Respir J. 2004;23(6):797-798. doi:10.1183/09031936.0.00018404


22. Zhao H., Wang L., Zhang Y., et al. Analysis of curative effect of adjuvant therapy with bronchoalveolar lavage on COPD patients complicated with pneumonia. Exp Ther Med. 2018. doi:10.3892/etm.2018.6662


23. Weinstein H.J., Bone R.C., Ruth W.E. Pulmonary lavage in patients treated with mechanical ventilation. Chest. 1977;72(5):583-587. doi:10.1378/chest.72.5.583


24 Christenson S.A., Kunz J.H., Soler X., et al. Chronic obstructive pulmonary disease. Lancet. 2022;399(10342):2227-2242. doi:10.1016/s0140-6736(22)00470-6


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32. Spieth P.M., Knels L., Kasper M., et al. Effects of vaporized perfluorohexane and partial liquid ventilation on regional distribution of alveolar damage in experimental lung injury. Intensive Care Med. 2007;33(2):308-314. doi: 10.1007/s00134-006-0428-7.


33. de Abreu M.G., Quelhas A.D., Spieth P., et al. Comparative effects of vaporized perfluorohexane and partial liquid ventilation in oleic acid-induced lung injury. Anesthesiology. 2006;104(2):278-289. doi: 10.1097/00000542-200602000-00013.


34. Bonitenko E.U., Belyakova N.A., Barinov V.A., et al. The use of perfluorocarbons in the treatment of severe bronchopulmonary pathology. Part I: Classification of methods (analytical review). Medline.ru 2023;24:1368-1397. (in Russian)


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