Chest
Volume 105, Issue 6, June 1994, Pages 1642-1645
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Thoracic Urgery: Clinical Investigations
Amiodarone and the Development of ARDS After Lung Surgery

https://doi.org/10.1378/chest.105.6.1642Get rights and content

An evaluation of amiodarone as prophylactic treatment for supraventricular tachyarrhythmias after pulmonary surgery was stopped because of a high incidence of the adult respiratory distress syndrome (ARDS) after a pneumonectomy. Retrospective analysis of all cases of resection for pulmonary neoplasm in our hospital between 1987 and 1991 indicates that amiodarone may be implicated in the development of ARDS after lung surgery.

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METHODS

A prospective open randomized study was planned for 100 consecutive pneumonectomy and 200 consecutive lobectomy cases, comparing amiodarone, verapamil, or placebo as prophylactic treatment for atrial fibrillation.

All patients in whom a pulmonary resection was performed were considered for the study, within 1 h of return from surgery to the ICU. Exclusion criteria consisted of a heart rate of less than 50 beats per minute, systolic blood pressure below 100 mm Hg, atrial dysrhythmias, heart

RESULTS

The prospective study was interrupted on July 29, 1992, because of severe life threatening side effects in three postpneumonectomy patients in the amiodarone treatment group. At that time, 64 patients had been included after lobectomy and 32 patients after pneumonectomy.

The results are summarized in Table 1. Systemic hypotension occurred shortly after the start of the infusion of verapamil in nine patients and subsided rapidly after the cessation of verapamil therapy and fluid replacement.

Adult

DISCUSSION

Pulmonary toxicity is the most serious noncardiac side effect attributed to amiodarone therapy. The overall incidence of amiodarone pulmonary toxicity has been estimated at 5 to 10 percent of treated patients.8

Amiodarone-induced pulmonary disease usually appears as a subacute or chronic disease, although in some cases there may be rapid progression toward respiratory failure.9

The most common presentation is that of a relatively benign subacute illness, characterized by cough, dyspnea, and

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