1998
DOI: 10.1164/ajrccm.157.6.9609017
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Cardiopulmonary Effects of Aerosolized Prostaglandin E1 and Nitric Oxide Inhalation in Patients with Acute Respiratory Distress Syndrome

Abstract: Ten patients with acute respiratory distress syndrome (ARDS) received in random order nitric oxide (NO) inhalation, aerosolized prostaglandin E1 (PGE1), infusion of PGE1, or no intervention. Inhalation of either aerosolized PGE1 (10 +/- 1 ng/kg/min) or NO (7 +/- 1 ppm) reduced pulmonary vascular resistance (PVR) from 158 +/- 14 to 95 +/- 11 dyn . s/cm5/m2 (NO) and 100 +/- 12 dyn . s/cm5/m2 (aerosolized PGE1), and improved PaO2 from 78 +/- 3 to 96 +/- 5 mm Hg (NO) and 95 +/- 4 mm Hg (aerosolized PGE1) (p < 0.05… Show more

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Cited by 73 publications
(39 citation statements)
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“…However, lack of sustained improvement in 30 -46% of infants and the need for specialized delivery systems make the treatment expensive and limit availability. Several investigators have explored the use of aerosolized prostaglandin E 1 (PGE 1 ) as a selective pulmonary vasodilator in patients with respiratory failure to improve oxygenation because of its selective action not only on the pulmonary circulation, but also on well-ventilated lung units (2)(3)(4)(5). We have previously described the safety and feasibility of inhaled PGE 1 (IPGE 1 ) in NHRF in a phase I/II unblinded clinical trial (5).…”
mentioning
confidence: 99%
“…However, lack of sustained improvement in 30 -46% of infants and the need for specialized delivery systems make the treatment expensive and limit availability. Several investigators have explored the use of aerosolized prostaglandin E 1 (PGE 1 ) as a selective pulmonary vasodilator in patients with respiratory failure to improve oxygenation because of its selective action not only on the pulmonary circulation, but also on well-ventilated lung units (2)(3)(4)(5). We have previously described the safety and feasibility of inhaled PGE 1 (IPGE 1 ) in NHRF in a phase I/II unblinded clinical trial (5).…”
mentioning
confidence: 99%
“…a decrease in overall lung perfusion pressure and selective vasodilation in well ventilated lung areas, a direct anti-inflammatory effect of NO may be operative when this agent is delivered in a proper dose range [13]. Interestingly, the inhalative route of application turned out to also be suitable for the vasodilatory prostanoids PGI 2 and PGE 1 , as aerosolization of these agents was found to reduce pulmonary artery pressure and to improve ventilation-perfusion mismatch in patients with acute respiratory distress syndrome (ARDS) and severe pulmonary hypertension [14][15][16].…”
mentioning
confidence: 99%
“…In an in vitro study, we have demonstrated that the emitted dose of IPGE 1 following jet nebulization in a neonatal ventilator circuit was 32-40% (26). In the present study, we used a high dose of IPGE 1 , 1200 ng/kg/min, corresponding to a total dose of ~3,500 μg of PGE 1 administered over 24 h. Compared to doses known to reduce pulmonary hypertension in patients (8-300 ng/kg/min), this represents a high dose (7)(8)(9)20,28,36). A dose of 1200 ng/ kg/min was chosen as this represents a dose four times the maximal dose that has been reported in humans and when given over a 24-hour period represents the cumulative dose that would be delivered over several days in the clinically used doses.…”
Section: Discussionmentioning
confidence: 87%
“…Intravenous PGE 1 (ivPGE 1 ) and PGI 2 , potent vasodilators used empirically in the treatment of NHRF, are associated with systemic hypotension and worsening of oxygenation due to increased venous admixture (2)(3)(4)(5)(6). This has led investigators to explore the delivery of PGE 1 and PGI 2 directly to the lungs as an inhalation, thus minimizing systemic effects and achieving selective pulmonary vasodilation (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Compared to PGI 2 , PGE 1 has a shorter half-life, lower pH (6.3 versus 10.5), bronchodilator action, anti-proliferative and anti-inflammatory effects on the alveolar, interstitial and vascular spaces of the lung (8,(22)(23)(24)(25).…”
Section: Introductionmentioning
confidence: 99%