Abstract
Eight patients who developed pulmonary artery hypertension during the adult respiratory distress syndrome (ARDS) were treated with an infusion of prostacyclin (PGI2, 12.5–35.0 ng·kg−1·min−1) for 45 min. We examined whether reducing the right ventricular (RV) outflow pressures by PGI2 infusion would increase the right ventricular ejection fraction (RVEF) measured by thermodilution. PGI2 reduced the pulmonary artery pressure (PAP) from 35.6 to 29.1 mmHg (p<0.01). The cardiac index (CI) increased from 4.2 to 5.81·min−1·m−2 (p<0.01) partly due to an increased stroke volume. The decreased PAP together with the increased CI resulted in a fall of the calculated pulmonary vascular resistance index (PVRI, from 5.1 to 2.5 mmHg·min·m2·1−1,p<0.01). In the patients with subnormal baseline RVEF the increased stroke volume was associated with an increased RVEF (from 47.6% to 51.8%,p<0.05) suggesting improved RV function. This result was underscored by a significant relationship between the changes in PVRI and RVEF (r=0.789, Δ% RVEF=−2.11·ΔPVRI-1.45). Despite an increased venous admixture from 27.8% to 36.9% (p<0.05) the arterial PO2 remained constant resulting in an increased oxygen delivery from 657 to 894 ml·min−1·m−2 (p<0.01). We conclude that short term infusions of PGI2 increased CI concomitant to improved RV function parameters when baseline RVEF was depressed. Since improved oxygen availability should be a major goal in the management of patients with ARDS PGI2 may be useful to lower pulmonary artery pressure in ARDS.
Article PDF
Similar content being viewed by others
References
Zapol WM, Snider MT (1977) Pulmonary artery hypertension in severe acute respiratory failure. N Engl J Med 296:476–480
Zapol WM, Snider MT, Rie MA, Frikker M, Quinn DA (1985) Pulmonary circulation during adult respiratory distress, syndrome. In: Zapol WM, Falke KJ (eds) Acute respiratory failure. Dekker, New York, pp 241–273
Sibbald WJ, Driedger AA, Myers ML, Short AIK, Wells GA (1983) Biventricular function in the adult respiratory distress syndrome. Chest 84:126–134
Jardin F, Farcot FC, Boisante L, Curien N, Margairaz A, Bourdarias JP (1981) Influence of positive end-expiratory pressure on left ventricular performance. N Engl J Med 304:387–392
Eddy AC, Rice CL (1989) The right ventricle: an emerging concern in the multiply injured patient. J Crit Care 4:58–66
Radermacher P, Santak B, Assmann R, Falke KJ (1989) Prostaglandin E1 and right ventricular function in ARDS. Intensive Care Med 15:146–147
Sibbald WJ, Driedger AA, McCallum DM, Cunningham DG, Cheung H (1986) Nitroprusside infusion does not improve biventricular performance in patients with acute hypoxemic respiratory failure. J Crit Care 1:197–203
Rubin LJ, Groves BM, Reeves JT, Frosolono M, Handel F, Cato AE (1982) Prostacyclin-induced acute pulmonary vasodilation in primary pulmonary hypertension. Circulation 66:334–338
Bihari D, Smithies M, Gimson A, Tinker J (1987) The effects of vasodilation with prostacyclin on oxygen delivery and uptake in critically ill patients. N Engl J Med 317:397–403
Bunting S, Gryglewski R, Moncada S, Vane JR (1976) Arterial walls generate from prostaglandin endoperoxides a substance (prostaglandin X) which relaxes strips of mesenteric and coeliac arteries and inhibits platelet aggregation. Prostaglandins 12:897–913
Greene R, Zapol WM, Snider MT, Reid LM, Snow R, O'Connel RS Novalline RA (1981) Early bedside detection of pulmonary vascular occlusion during respiratory failure. Am Rev Respir Dis 124:591–601
Murray JF, Matthay MA, Luce JM, Flick MR (1988) An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis 138:720–723
Mancebo J, Artigas A (1987) A clinical study of the adult respiratory distress syndrome. Crit Care Med 15:243–246
Brunet F, Dhainaut JF, Devaux JY, Hughebaert MF, Villemant D, Monsallier JF (1988) Right ventricular performance in patients with acute respiratory failure. Intensive Care Med 14[Suppl 2]: 474–477
Jansen JR, Schreuder JJ, Bogaard JM, van Royen W, Versprille A (1981) Thermodilution technique for measurement of cardiac output during artificial ventilation. J Appl Physiol 50:584–591
Assmann R, Falke KJ (1988) Pressure and volume assessment of right ventricular function during mechanical ventilation. Intensive Care Med 14:[Suppl 2]467–470
Assmann R, Falke KJ (1987) Cyclic modulation of thermal right ventricular ejection fraction during controlled mechanical ventilation. Intensive Care Med 13:217–218
Vincent JL, Reuse C, Kahn RJ (1988) Effect on right ventricular function of a change from dopamine to dobutamine in critically ill patients. Crit Care Med 16:659–662
Scheidegger D (1987) Coronary perfusion of the right ventricle. In: Vincent JL, Suter PM (eds) Cardiopulmonary interactions in acute respiratory failure. Springer, Berlin, pp 61–71
Schwartz D (1963) Méthodes statistiques à usage des médecins et des biologistes. Flammarion, Paris
Vincent JL (1987) Pharmacological interventions in acute respiratory failure. In: Vincent JL, Suter PM (eds) Cardiopulmonary interactions in acute respiratory failure. Springer, Berlin, pp 226–233
Yui Y, Nakajima H, Kawai C, Murakami A (1982) Prostacyclin therapy in patients with congestive heart failure. Am J Cardiol 50:320–324
Vlahakes GJ, Turley K, Hoffman JIE (1981) The pathophysiology of failure in acute right ventricular hypertension: hemodynamic and biochemical considerations. Circulation 63:87–95
Endrich B, Franke N, Peter K, Messmer K (1987) Induced hypotension: action of sodium nitroprusside and nitroglycerin on the micorcirculation. Anesthesiology 66:605–613
Bihari DJ, Tinker J (1989) The therapeutic value of vasodilator prostaglandins in multiple organ failure associated with sepsis. Intensive Care Med 15:2–7
Radermacher P, Huet Y, Pluskwa F, Hérigault R, Mai H, Teisseire B, Lemaire F (1988) Comparison of ketanserin and sodium nitroprusside in patients with severe ARDS. Anesthesiology 68:152–157
Radermacher P, Santak B, Becker H, Falke KJ (1989) Prostaglandin E1 and nitroglycerin reduce pulmonary capillary pressure but worsen\(\dot V_A /\dot Q\) distributions in patients with adult respiratory distress syndrome. Anesthesiology 70:601–606
Kariman K, Burns SR (1985) Regulation of tissue oxygen extraction is disturbed in adult respiratory distress syndrome. Am Rev Respir Dis 132:109–114
Mohsenifar Z, Goldbach P, Tashkin DP, Campisi DJ (1983) Relationship between O2 delivery and O2 consumption in the adult respiratory distress syndrome. Chest 84:267–271
Allen SJ, Drake RE, Katz J, Gabel JC, Laine GA (1987) Lowered pulmonary arterial pressure prevents edema formation after endotoxin in sheep. J Appl Physiol 63:1008–1011
Gottlieb SS, Wood LDH, Hansen DE, Long R (1987) The effect of nitroprusside on pulmonary edema, oxygen exchange, and blood flow in hydrochloric acid aspiration. Anesthesiology 67:203–210
Author information
Authors and Affiliations
Additional information
Supported by the Deutsche Forschungsgemeinschaft (grant Fa 139/2-2)
Rights and permissions
About this article
Cite this article
Radermacher, P., Santak, B., Wüst, H.J. et al. Prostacyclin and right ventricular function in patients with pulmonary hypertension associated with ARDS. Intensive Care Med 16, 227–232 (1990). https://doi.org/10.1007/BF01705156
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01705156