Are inhaled vasodilators useful in acute lung injury and acute respiratory distress syndrome?
In patients with acute respiratory distress syndrome (ARDS), inhaled vasodilator can result in important physiologic benefits (eg, improved hypoxemia, lower pulmonary arterial pressure, and improved right-ventricular function and cardiac output) without systemic hemodynamic effects. Inhaled nitric oxide (INO) and aerosolized prostacyclins are currently the most frequently used inhaled vasodilators. Inhaled prostacyclins are as effective physiologically as INO and cost less. Randomized controlled trials of INO in the treatment of ARDS have shown short-term physiologic benefits, but no benefit in long-term outcomes. No outcome studies have been reported on the use of prostacyclin in patients with ARDS. There is no role for the routine use of inhaled vasodilators in patients with ARDS. Inhaled vasodilator as a rescue therapy for severe refractory hypoxemia in patients with ARDS may be reasonable, but is controversial.
Siobal
Mark S
MS
Respiratory Care Services, NH GA2, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco CA 94110, USA. msiobal@sfghsom.ucsf.edu
Hess
Dean R
DR
D055371:Acute Lung Injury / Q000188:drug therapy* / Q000503:physiopathology; D000280:Administration, Inhalation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000517:prevention & control; D009569:Nitric Oxide / Q000008:administration & dosage*; D011175:Positive-Pressure Respiration; D044062:Prostaglandins I / Q000008:administration & dosage*; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000188:drug therapy*; D014665:Vasodilator Agents / Q000008:administration & dosage*; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology
D044062:Prostaglandins I; D014665:Vasodilator Agents; D009569:Nitric Oxide