Is amiodarone an underrecognized cause of acute respiratory failure in theICU?

Amiodarone is a commonly used anti-arrhythmic agent, with well-recognized c hronic toxicity, Less well known is amiodarone's potential to cause acute l ung damage, which can be severe or, occasionally, life-threatening. Lungs t hat have already been exposed to physical insults, such as the lungs of pat ients undergoing cardiac surgery, are particularly susceptible to acute pul monary toxicity (APT), Unfortunately, cardiac surgery is one of the clinica l scenarios in which amiodarone is most commonly used. After reviewing the data, and even in the context of difficulties and discrepancies in the exis ting literature, we contend that there is sufficient evidence of amiodarone 's potentially serious side-effect profile in surgical ICU patients to advi se continued caution in its use with this severely ill patient group. We su ggest that amiodarone has a potentially important, though underrecognized, role in inducing an APT/ARDS in some patients, such as those undergoing car diac surgery. We :also provide a hypothesis to explain the mechanism by whi ch amiodarone causes lung damage.