CARDIOPULMONARY EFFECTS OF AEROSOLIZED PROSTAGLANDIN E-1 AND NITRIC-OXIDE INHALATION IN PATIENTS WITH ACUTE RESPIRATORY-DISTRESS SYNDROME

Ten patients with acute respiratory distress syndrome (ARDS) received in random order nitric oxide (NO) inhalation, aerosolized prostaglandi n E-1 (PGE(1)), infusion of PCE1, or no intervention. Inhalation of ei ther aerosolized PCE1 (10 +/- 1 ng/kg/min) or NO (7 +/- 1 ppm) reduced pulmonary vascular resistance (PVR) from 158 +/- 14 to 95 +/- 11 dyn. s/cm(5)/m(2) (NO) and 100 +/- 12 dyn.s/cm(5)/m(2) (aerosolized PGE(1)) , and improved Pa-O2 from 78 +/- 3 to 96 +/- 5 mm Hg (NO) and 95 +/- 4 mm Hg (aerosolized PGE(1)) (p < 0.05), venous admixture (Q(VA)/Q(T)) from 45 +/- 2 to 36 +/- 2% (NO), and 36 +/- 2% (aerosolized PCE1) (p < 0.05), oxygen delivery (Do(2)) from 711 +/- 34 to 762 +/- 45 ml/min/m (2) (NO) and 780 +/- 46 ml/min/m(2) (aerosolized PGE(1)) (p < 0.05), a nd right ventricular ejection fraction (RVEF) from 32 +/- 6 to 37 +/- 5% (NO), and 36 +/- 4% (aerosolized PGE(1)) (p < 0.05) at a constant c ardiac index (CI). Although infusion of PCE, (12 +/- 1 ng/kg/min) caus ed a similar reduction in PVR as aerosolized PGE(1) and NO inhalation, it improved RVEF and increased Cl but decreased Q(VA)/Q(T) and Pa-O2. These results suggest that in ARDS patients inhalation of aerosolized PGE(1) or NO in low concentrations equally improves PVR and gas excha nge by selective vasodilation in ventilated areas.