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Prostaglandin E1 and survival in patients with adult respiratory distress syndrome. A prospective trial
ABSTRACTS
Hg; p < 0.05) (mean ± SD) and subsequently remained low throughout the experiment. Simultaneously, pulmonary lymph flow increased by 24 hours (11.5 ± 4.9 to 26.7 ± 13 ml/hr; p < 0,05) and remained elevated throughout the experiment while [L/P] total protein ratios remained unchanged at 24 hours (baseline: 0.59 ± 0.15 at 24 hours: 0.65 ± 0.16). Morphologic examination of the lung showed that this model of peritonitis was characterized by neutrophil emigration into the pulmonary interstitium by 24 hours and interstitial edema by 48 hours. Therefore this model of bacterial peritonitis in sheep demonstrates that one of the remote effects of surgically induced systemic sepsis is an increase in permeability of the pulmonary mierovascular membrane. (Reprinted with permission.) Pulmonary and Systemic Consequences of Localized Acid Aspiration. Manny J, Manny IV. Lelcuk S, et el. Surf
Gynecol Obstet 162:259, 1986. Acid aspiration may recruit a generalized inflammatory reaction that can potentiate the local injury. After surgical isolation of bronchi in a group of 15 dogs, 1 milliliter per kilogram of 0.37 normal hydrocholric acid was instilled into either side. After five minute.~, platelet and white blood cell counts fell to I0,000 and 1,000 per cubic millimeter (p < 0.05). Platelet aggregates were noted in blood smears, L'lndium-platclet activity doubled over both the aspirated and nonaspirated lung (p < 0.05). Physiologic dead space rose from ! 8 to 67 per cent and to 46 per cent in the aspirated and nonaspirated lung (p < 0.05). Physiologic shunt increased from 12 to 47 per cent and to 43 per cent (p < 0.05) on the two sides. Plasma thromboxane B2 levels at 30 minutes rose from 0.28 to 0.93 nanograms per milliliter (p < 0.05). Edema fluid from the aspirated lung had thromboxane B: values of 2.87 nanograms per milliliter, indicating pulmonary synthesis. Within five minutes of aspiration, systemic effects were prominent; mean arterial pressure fell from 114 to 46 milliliters of mercury (p < 0.05), and the cardiac index fell 24 per cent from 106 to 81 milliliters per kilogram per minute (p < 0.05) along with an 18 per cent decrease in contractility e r a rat papillary muscle bathed in plasma from the aspirated dog. Mean pulmonary arterial pressure rose from 12 to 18 millimeters of mercury (p < 0.05). Despite fluid infusion at 36 milliliters per kilogram per hour to keep wedge pressure constant at 5.5 millimeters of mercury, and sampling of one-third the blood volume, hemoglobin concentration rose 0.9 grams per cent (p < 0.05) indicating increased mierovascular permeability. At autopsy, the aspirated and nonaspirated lung were indistinguishable with congestion, interstitial hemorrhage, and white blood cell infiltrates. Systemic organs showed vascular congestion and edema. These data demonstrate that local aspiration leads to generalized inflammatory sequelae with cardiopulmonary failure. (Reprinted with permission.)
261 Increased Lung Capillary Permeability after Trauma: A
Prospective Clinical Study. Slur~z JA, Wisher DH, Oestern H-J, el aL J Trauma 26:409, 1986. Pulmonary dysfunction and permeability were prospectively studied in a group of severely traumatized patients. Ventilatory parameters (i.e., PaO2/FiO2, dynamic compliance, per cent shunt, and A-a DO2) and extravascular lung water (EVLW) measurements were compared with seintigraphic determinations of pulmonary albumin extravasation. Albumin extravasation data demonstrated a pulmonary capillary permeability increase occurring shortly following trauma. The medium albumin extravasation value in the patients within 24 hours of trauma was 3.6 × I O-~/sec, compared to a control value of -O.I + 0.7 x lO'~/sec, Intermediate levels of albumin extravasation were found in patients studied within 48 hours of total hip replacement (I.6 ± 0.9 x lO'S/ see). Eighty per cent of patients studied within the first 48 hours of their trauma had albumin extravasation values exceeding the upper limit of normal as determined by the control value + 2 S.D. In contrast to albumin extravasation values, the PaO2/FiO2, dynamic compliance, per cent shunt, A-a DOs, and EVLW did not begin to deteriorate significantly until at least 48 hours after trauma. We conclude that severe multiple trauma induces an early increase in pulmonary capillary permeability as measured by albumin extravasation scintigraphy. This change is not detectable with other commonly used measures. (Reprinted with permission.) Prostaglandin E1 and Survival in Patients With Adult Respiratory Distress Syndrome, A Prospective Trial. Holcrofi
JW, Vassar MJ. Weber CJ. Ann Surg 203:371, t986. A 7-day infusion of prostaglandin El (PGEI), an immunemodulator, was evaluated in a prospective, randomized, placebo-controlled, doubl~-blinded trial in surgical patients with the adult respiratory distress syndrome (ARDS). The drug seemed to improve pulmonary function---only two PGEj patients died with severe pulmonary failure compared with nine placebo patients (p = 0.01 ). Survival at 30 days after the end of the infusion--the predetermined end point of the study--was significantly better in the patients given PGE~ (p - 0.03), with 15 of 21 PGE~ patients (71%) alive at this time compared with seven of 20 placebo patients (35%). Improvement in overall survival in the PGE~ patients did not reach statistical significance (p =. 0.08). Overall survival in patients initially free of severe organ failure, however, was significantly better in the PGE~ patients (p - 0.03). Of the six PGEt patients free of severe organ failure at time of entry, all survived to leave the hospital; of the 10 placebo patients initially free of severe organ failure, four survived. The drug had no serious side effects and did not potentiate susceptibility to infection. PGEz is a promising agent for the treatment of ARDS. (Reprinted with permission.)
Hg; p < 0.05) (mean ± SD) and subsequently remained low throughout the experiment. Simultaneously, pulmonary lymph flow increased by 24 hours (11.5 ± 4.9 to 26.7 ± 13 ml/hr; p < 0,05) and remained elevated throughout the experiment while [L/P] total protein ratios remained unchanged at 24 hours (baseline: 0.59 ± 0.15 at 24 hours: 0.65 ± 0.16). Morphologic examination of the lung showed that this model of peritonitis was characterized by neutrophil emigration into the pulmonary interstitium by 24 hours and interstitial edema by 48 hours. Therefore this model of bacterial peritonitis in sheep demonstrates that one of the remote effects of surgically induced systemic sepsis is an increase in permeability of the pulmonary mierovascular membrane. (Reprinted with permission.) Pulmonary and Systemic Consequences of Localized Acid Aspiration. Manny J, Manny IV. Lelcuk S, et el. Surf
Gynecol Obstet 162:259, 1986. Acid aspiration may recruit a generalized inflammatory reaction that can potentiate the local injury. After surgical isolation of bronchi in a group of 15 dogs, 1 milliliter per kilogram of 0.37 normal hydrocholric acid was instilled into either side. After five minute.~, platelet and white blood cell counts fell to I0,000 and 1,000 per cubic millimeter (p < 0.05). Platelet aggregates were noted in blood smears, L'lndium-platclet activity doubled over both the aspirated and nonaspirated lung (p < 0.05). Physiologic dead space rose from ! 8 to 67 per cent and to 46 per cent in the aspirated and nonaspirated lung (p < 0.05). Physiologic shunt increased from 12 to 47 per cent and to 43 per cent (p < 0.05) on the two sides. Plasma thromboxane B2 levels at 30 minutes rose from 0.28 to 0.93 nanograms per milliliter (p < 0.05). Edema fluid from the aspirated lung had thromboxane B: values of 2.87 nanograms per milliliter, indicating pulmonary synthesis. Within five minutes of aspiration, systemic effects were prominent; mean arterial pressure fell from 114 to 46 milliliters of mercury (p < 0.05), and the cardiac index fell 24 per cent from 106 to 81 milliliters per kilogram per minute (p < 0.05) along with an 18 per cent decrease in contractility e r a rat papillary muscle bathed in plasma from the aspirated dog. Mean pulmonary arterial pressure rose from 12 to 18 millimeters of mercury (p < 0.05). Despite fluid infusion at 36 milliliters per kilogram per hour to keep wedge pressure constant at 5.5 millimeters of mercury, and sampling of one-third the blood volume, hemoglobin concentration rose 0.9 grams per cent (p < 0.05) indicating increased mierovascular permeability. At autopsy, the aspirated and nonaspirated lung were indistinguishable with congestion, interstitial hemorrhage, and white blood cell infiltrates. Systemic organs showed vascular congestion and edema. These data demonstrate that local aspiration leads to generalized inflammatory sequelae with cardiopulmonary failure. (Reprinted with permission.)
261 Increased Lung Capillary Permeability after Trauma: A
Prospective Clinical Study. Slur~z JA, Wisher DH, Oestern H-J, el aL J Trauma 26:409, 1986. Pulmonary dysfunction and permeability were prospectively studied in a group of severely traumatized patients. Ventilatory parameters (i.e., PaO2/FiO2, dynamic compliance, per cent shunt, and A-a DO2) and extravascular lung water (EVLW) measurements were compared with seintigraphic determinations of pulmonary albumin extravasation. Albumin extravasation data demonstrated a pulmonary capillary permeability increase occurring shortly following trauma. The medium albumin extravasation value in the patients within 24 hours of trauma was 3.6 × I O-~/sec, compared to a control value of -O.I + 0.7 x lO'~/sec, Intermediate levels of albumin extravasation were found in patients studied within 48 hours of total hip replacement (I.6 ± 0.9 x lO'S/ see). Eighty per cent of patients studied within the first 48 hours of their trauma had albumin extravasation values exceeding the upper limit of normal as determined by the control value + 2 S.D. In contrast to albumin extravasation values, the PaO2/FiO2, dynamic compliance, per cent shunt, A-a DOs, and EVLW did not begin to deteriorate significantly until at least 48 hours after trauma. We conclude that severe multiple trauma induces an early increase in pulmonary capillary permeability as measured by albumin extravasation scintigraphy. This change is not detectable with other commonly used measures. (Reprinted with permission.) Prostaglandin E1 and Survival in Patients With Adult Respiratory Distress Syndrome, A Prospective Trial. Holcrofi
JW, Vassar MJ. Weber CJ. Ann Surg 203:371, t986. A 7-day infusion of prostaglandin El (PGEI), an immunemodulator, was evaluated in a prospective, randomized, placebo-controlled, doubl~-blinded trial in surgical patients with the adult respiratory distress syndrome (ARDS). The drug seemed to improve pulmonary function---only two PGEj patients died with severe pulmonary failure compared with nine placebo patients (p = 0.01 ). Survival at 30 days after the end of the infusion--the predetermined end point of the study--was significantly better in the patients given PGE~ (p - 0.03), with 15 of 21 PGE~ patients (71%) alive at this time compared with seven of 20 placebo patients (35%). Improvement in overall survival in the PGE~ patients did not reach statistical significance (p =. 0.08). Overall survival in patients initially free of severe organ failure, however, was significantly better in the PGE~ patients (p - 0.03). Of the six PGEt patients free of severe organ failure at time of entry, all survived to leave the hospital; of the 10 placebo patients initially free of severe organ failure, four survived. The drug had no serious side effects and did not potentiate susceptibility to infection. PGEz is a promising agent for the treatment of ARDS. (Reprinted with permission.)