Five years ago, Malloy was staring down at a tiny female whose 25-week-old, surfactant-starved lungs had just that look. Dangerously high ventilator settings couldn't improve her oxygenation. Clinicians at Thomas Jefferson Medical Center in Philadelphia tried giving her a dose of artificial surfactant, then switched her to high frequency ventilation, then considered giving her another dose of surfactant but ruled that out, and finally asked themselves: Is she a candidate for our liquid ventilation trial?

Luckily, she fit the criteria to a tee.

"We started her on LV and, from the first few hours, she responded great," Malloy recalls.

So began another rescue from the black hole of respiratory failure, courtesy of liquid ventilation, a modality that beckons like a gift from some advanced civilization.

From a glass syringe attached to the endotracheal tube, the special liquid compound trickled down into the infant's lungs. Every hour or two, a respiratory therapist "popped" her off the vent and peered down with a laryngoscope to the back of her throat, looking at the ET tube for what is called the meniscus, a sign that the liquid filled her lungs to capacity.

Soon, the baby's alveoli opened, her gas exchange improved. The team could dial down her ventilator to safer pressures as it recruited dead atelectatic space, oxygenated her and removed CO2.

"We weaned her on low ventilator settings and, after a few days, dramatically low settings," Malloy explains. "We cut back on new LV applications to once every three hours, once every six hours, once every 12 hours, until eventually we weaned her off."

Today, the happy, healthy child attends kindergarten. Her mother, a nurse at Jefferson, keeps the team supplied with new photos of her. "She has no idea all the trouble she caused her parents," Malloy says.