Vasodilators in mechanical ventilation.
Vasodilators that affect the pulmonary vasculature are appealing adjuncts in many cardiopulmonary conditions that require mechanical ventilation such as ARDS, COPD, PPHN, and cardiothoracic surgery. The adverse systemic effects of parenteral PGE1 and parenteral prostacyclin limit their usefulness in critically ill patients. Liposomal PGE1 has few systemic effects, but thus far has not resulted in a significant clinical benefit in patients with ARDS. Inhaled NO and aerosolized prostacyclin offer the advantage of selective pulmonary vasodilation with minimal systemic effects. Both agents decrease PAP and in many clinical situations improve oxygenation; however, the physiologic effects of inhaled NO and aerosolized prostacyclin have not convincingly led to improved clinical outcomes. Currently, use of vasodilators in mechanically ventilated patients remains investigational.
Zimmerman
J L
JL
Baylor College of Medicine, Houston, Texas, USA.
Hanania
N A
NA
D000280:Administration, Inhalation; D000527:Alprostadil / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D011464:Epoprostenol / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D008171:Lung Diseases / Q000188:drug therapy* / Q000628:therapy*; D009569:Nitric Oxide / Q000627:therapeutic use; D010101:Oxygen Consumption / Q000187:drug effects; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D012121:Respiration, Artificial / Q000379:methods*; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D009569:Nitric Oxide; D011464:Epoprostenol; D000527:Alprostadil