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.
We wanted to determine the long-term effects of a continuous infusion of PGE1 on DO2 and VO2 in patients with ARDS. Data were obtained from a randomized double-blind multicenter trial, which evaluated the effects of PGE1 on survival in patients with ARDS. Patients were stratified according to treatment and outcome: placebo-died (n = 8); PGE1-died (n = 12); placebo-survived (n = 9); and PGE1-survived (n = 8). In the placebo-died group, elevations occurred in VO2, which were associated with increases in O2ext and a constant DO2. In contrast, in the PGE1-died group, elevations in VO2 were associated with increases in DO2 and an unchanged O2ext. In the placebo-survived group, VO2 and DO2 decreased, whereas in the PGE1-survived group, VO2 and DO2 increased; however, O2ext decreased in both of these groups. Since impaired O2ext occurs in ARDS, PGE1-induced elevations in DO2, rather than compensatory increases in O2ext, may achieve better tissue oxygenation. We conclude that although the recently completed multicenter trial failed to show an enhancing effect of PGE1 on survival in patients with advanced ARDS, PGE1 may have important effects on oxygen transport and, therefore, may still have a role in the treatment of early manifestations of ARDS, either alone or in combination with other agents.
University of Maryland Hospital, Baltimore 21201.
H J
HJ
Silverman
G
G
Slotman
R C
RC
Bone
R
R
Maunder
T M
TM
Hyers
M D
MD
Kerstein
J J
JJ
Ursprung
D000527:Alprostadil / Q000627:therapeutic use*; D002302:Cardiac Output / Q000187:drug effects; D006801:Humans; D015337:Multicenter Studies as Topic; D010101:Oxygen Consumption / Q000187:drug effects; D010919:Placebos; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D016032:Randomized Controlled Trials as Topic; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000401:mortality; D014481:United States / Q000453:epidemiology
D010919:Placebos; D000527:Alprostadil