Cardiopulmonary effects of lipid emulsions in patients with ARDS.
OBJECTIVE
Lipid emulsions have been suspected of inducing certain modifications in gas exchange and pulmonary hemodynamics. The aim of this prospective study was to evaluate the hemodynamic and pulmonary effects of two lipid emulsions.


METHODS
Prospective, randomized, double-blind, crossover study.


METHODS
Medical and surgical ICU in a French university hospital.


METHODS
Eighteen patients presenting ARDS.


METHODS
Each patient received a 6-h infusion of a 20% fat emulsion containing 100% long-chain triglycerides (LCTs) and a 6-h infusion of 50% LCTs/50% medium-chain triglycerides (MCTs) 20% lipid emulsion at the rate of 1.0 mL/kg/h. An 18-h period with no lipids separated the two periods. An additional 18-h period after the end of the second lipid emulsion administration was observed prior to the final measurements.


RESULTS
The MCT/LCT emulsion increased the PaO(2)/fraction of inspired oxygen (FIO(2)) ratio (p = 0.005) compared with LCT emulsion alone. The mean (+/- SD) PaO(2)/FIO(2) ratio increased from 165 +/- 55 to 191 +/- 64 mm Hg after 1 h of LCT/MCT administration (p < 0.03), and to 175 +/- 46 mm Hg after 6 h. Moreover, there was an increase in oxygen delivery after 6 h of LCT/MCT administration (p < 0.001 vs baseline). While a time-related increase in mean pulmonary artery pressure (p = 0.012) during lipid administration was found, no effect of the kind of lipid emulsion was observed. The time-related increase in cardiac index (p = 0.002) was more marked when the patients received the LCT/MCT emulsion (p = 0.002). Pulmonary vascular resistances were not affected by the kind of lipid emulsion.


CONCLUSIONS
The present work showed that while the LCT emulsion induced no deleterious effects on oxygenation in ARDS patients, the LCT/MCT emulsion improved the PaO(2)/FIO(2) ratio and had a further beneficial effect on oxygen delivery.
Faucher
Marion
M
Service de Réanimation Polyvalente, Hôpitaux Sud, Marseille, France.
Bregeon
Fabienne
F
Gainnier
Marc
M
Thirion
Xavier
X
Auffray
Jean-Pierre
JP
Papazian
Laurent
L
D018592:Cross-Over Studies; D004311:Double-Blind Method; D005217:Fat Emulsions, Intravenous / Q000737:chemistry / Q000494:pharmacology*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange / Q000187:drug effects; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D013997:Time Factors; D014280:Triglycerides / Q000494:pharmacology
D005217:Fat Emulsions, Intravenous; D014280:Triglycerides