The Effect of Liposome-Encapsulated PGE1 on Systemic Oxygen Delivery and Consumption in Patients With the Acute Respiratory Distress Syndrome

Abstract

The goal of this study was to determine the effect of liposome-encapsulated prostaglandin E₁ (PGE₁) on oxygen delivery and consumption and hemodynamics in patients with the acute respiratory distress syndrome (ARDS). Mechanically ventilated patients with ARDS and pulmonary artery catheters who were in the intensive care unit (ICU) were enrolled within 24 hours of diagnosis. Treatment consisted of either liposomal PGE₁ or placebo every 6 hours in a dose-escalating fashion for up to 7 days. Cardiac index (CI), systemic vascular resistance index (SVRI), oxygen delivery (D₂) and consumption (VO₂), and oxygen extraction ratio were determined every morning before and after the dose of study drug using arterial and mixed venous blood gases and standard formulas. No significant differences in any of the variables were observed over time or between groups. Liposomal PGE₁ administered in this fashion does not alter hemodynamic parameters or oxygen transport variables in patients with ARDS.

Keywords

acute respiratory distress syndrome (ARDS)oxygen delivery oxygen consumption liposomes prostaglandin E1 cardiac index

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References

Holtzman MJ. Arachidonic acid metabolism. Implications of biological chemistry for lung function and disease. Am Rev Respir Dis 1991;143:188-203.

Hsu MJ , Juliano RL. Interactions of liposomes with the reticuloendothelial system. II: nonspecific and receptor-mediated uptake of liposomes by mouse peritoneal macrophages. Biochim Biophys Acta 1982;720:411-419.

Eierman DF , Yagami M , Erme SM , et al. Endogenously opsonized particles divert prostanoid action from lethal to protective in models of experimental endotoxemia. Proc Natl Acad Sci USA 1995;92:2815-2819.

Abraham E , Baughman R , Fletcher E , et al. Liposomal prostaglandin E1 (TLC C-53) in acute respiratory distress syndrome: a controlled, randomized, double-blind, multi-center clinical trial. TLC C-53 ARDS Study Group. Crit Care Med 1999;27:1478-1485.

Bone RC , Slotman G , Maunder R , et al. Randomized double-blind, multicenter study of prostaglandin E1 in patients with the adult respiratory distress syndrome. Prostaglandin E1 Study Group. Chest 1989;96:114-119.

Appel PL , Shoemaker WC. Hemodynamic and oxygen transport effects of prostaglandin E1 in patients with adult respiratory distress syndrome. Crit Care Med 1984;12:528-529.

Shoemaker WC , Appel PL. Effects of prostaglandin E1 in adult respiratory distress syndrome. Surgery 1986;99:275-283.

Silverman HJ , Slotman G , Bone RC , et al. Effects of prostaglandin E1 on oxygen delivery and consumption in patients with the adult respiratory distress syndrome. Results from the prostaglandin E1 multicenter trial. The Prostaglandin E1 Study Group. Chest 1990;98:405-410.

Russell JA , Ronco JJ , Dodek PM. Physiologic effects and side effects of prostaglandin E1 in the adult respiratory distress syndrome. Chest 1990;97:684-692.

10.

Kunimoto F , Arai K , Isa Y , et al. A comparative study of the vasodilator effects of prostaglandin E1 in patients with pulmonary hypertension after mitral valve replacement and with adult respiratory distress syndrome. Anesth Analg 1997;85:507-513.

11.

Melot C , Lejeune P , Leeman M , et al. Prostaglandin E1 in the adult respiratory distress syndrome. Benefit for pulmonary hypertension and cost for pulmonary gas exchange. Am Rev Respir Dis 1989;139:106-110.

12.

Radermacher P , Santak B , Becker H , et al. Prostaglandin E1 and nitroglycerin reduce pulmonary capillary pressure but worsen ventilation-perfusion distributions in patients with adult respiratory distress syndrome. Anesthesiology 1989;70:601-606.

13.

Tokioka H , Kobayashi O , Ohta Y , et al. The acute effects of prostaglandin E1 on the pulmonary circulation and oxygen delivery in patients with the adult respiratory distress syndrome. Intensive Care Med 1985;11:61-64.

14.

Cox JW , Andreadis NA , Bone RC , et al. Pulmonary extraction and pharmacokinetics of prostaglandin E1 during continuous intravenous infusion in patients with adult respiratory distress syndrome. Am Rev Respir Dis 1988;137:5-12.

15.

Holcroft JW , Vassar MJ , Weber CJ. Prostaglandin E1 and survival in patients with the adult respiratory distress syndrome. A prospective trial. Ann Surg 1986;203:371-378.