Nebulized prostacyclin (PGI2) in acute respiratory distress syndrome: impact of primary (pulmonary injury) and secondary (extrapulmonary injury) disease on gas exchange response.

摘要: Objectives: To examine the hypothesis that response to inhaled prostacyclin (PGI 2 ) on oxygenation and pulmonary hemodynamics may be related different morphologic features are supposed present in acute respiratory distress syndrome (ARDS) originating from (primary ARDS [ARDS PR ]) extrapulmonary disease (secondary SEC ]). Design: Prospective, nonrandomized interventional study. Setting: Multidisciplinary intensive care unit, secondary center. Patients: Fifteen consecutive, mechanically ventilated patients with severe hypoxemia, defined as Pao /Fio of <150 torr at time admission. Interventions: After an initial stable period least 60 mins, received nebulized PGI 15-min steps; drug was titrated find dose best improvement , starting ng/kg/min up allowed maximum 40 ng/kg/min. Measurements Main Results: Blood gas, gas exchange, hemodynamic measurements were performed following points: a) baseline; b) during optimal or ; c) 1 hr after withdrawal drug. Patients underwent a computed tomographic (CT) scan using basal CT section compute mean numbers density histogram. considered responders if increase ≥7.5 ratio ≥10% occurred. For group whole, artery pressure decreased 32 ± 29 mm Hg nebulization, whereas vascular resistance nebulization 177 18 153 16 dyne.sec/cm 5 did not change significantly. Eight responded (all ARDSSEC subgroup), seven but one ARDSPR subgroup). Among physiologic variables examined assess any difference between two groups there significant concerning number, which -445 22 Hounsfield Units -258 group. In presenting induced reduction 87 79 torr, 76 4 84 decrease pressure. Conclusions: Based data this study, clinical recognition types together number frequency distribution analysis associated prediction oxygenation.