Adverse effects of prostacyclin administered directly into patients with combined renal and respiratory failure prior to dialysis.
We infused prostacyclin into 11 critically ill patients for 30 min at a rate of 5 ng/kg.min, prior to commencing prostacyclin haemodialysis. All patients had combined respiratory and renal failure and required intropic support. Despite the previous correction of hypovolaemia, prostacyclin produced a decrease in mean arterial pressure, pulmonary and systemic vascular resistances and cardiac filling pressures. There was no compensatory increase in cardiac output and due to an increase in pulmonary ventilation/perfusion mismatch an overall decrease in tissue oxygen delivery from a median of 560 ml/min.m2 to 370 ml/min.m2 was noted p less than 0.05, with a corresponding reduction in tissue oxygen uptake from 140 ml/min.m2 to 125 ml/min.m2. This was associated with an increase in both arterial hydrogen ion and lactate concentrations in 8 of the 11 patients studied, suggesting a deterioration in tissue oxygen supply/oxygen requirement. Prostacyclin should not be infused directly into patients unless monitored to assess the therapeutic/adverse effects on an individual patient basis.
Davenport
A
A
Department of Renal Medicine, St. James's University Hospital, Leeds, UK.
Will
E J
EJ
Davison
A M
AM
D058186:Acute Kidney Injury / Q000150:complications / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000097:blood; D011464:Epoprostenol / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D012131:Respiratory Insufficiency / Q000150:complications / Q000188:drug therapy*
D002245:Carbon Dioxide; D011464:Epoprostenol; D010100:Oxygen