title: Inhaled prostacyclin in combination with high-frequency percussive ventilation.
abstract: We present a case of severe acute respiratory distress syndrome pursuant to inhalation of a compressed gas computer keyboard cleaner. Despite the use of multimodal therapy to include empiric antibiotics, intravenous paralytics, intravenous concentrated albumin, high-dose corticosteroids as well as sustained high mean airway pressure mechanical ventilation by airway pressure release and high-frequency percussive ventilation (HFPV) modes, the patient demonstrated an unchanging arterial oxygen tension/fraction of inspired oxygen ratio of only 57 mm Hg. A trial of nebulized prostacyclin was initiated during HFPV leading to a significant improvement in arterial oxygen tension/fraction of inspired oxygen to 147 mm Hg. The improved oxygen tension allowed for a reduction in mean airway pressure and oxygen concentration as well the safe aeromedical evacuation of the patient from the combat theater. Further, prospective studies are required to validate the magnitude of response to inhaled prostacyclin during HFPV.
authors.affiliation: Landstuhl Regional Medical Center, Landstuhl, Germany.
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Allan
authors.forename: Cindy A
authors.initials: CA
authors.lastname: Codispoti
authors.forename: Shannon G
authors.initials: SG
authors.lastname: Womble
authors.forename: Michael L
authors.initials: ML
authors.lastname: Overton
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Wanek
authors.forename: John H
authors.initials: JH
authors.lastname: Sherner
authors.forename: Raymond
authors.initials: R
authors.lastname: Fang
authors.forename: Steven V
authors.initials: SV
authors.lastname: Silvey
mesh_terms: D000336:Aerosols / Q000506:poisoning*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D011464:Epoprostenol / Q000008:administration & dosage / Q000627:therapeutic use*; D006612:High-Frequency Ventilation / Q000379:methods*; D006801:Humans; D019570:Inhalation Exposure; D008297:Male; D012128:Respiratory Distress Syndrome / Q000139:chemically induced* / Q000628:therapy*; D019966:Substance-Related Disorders / Q000150:complications*; D055815:Young Adult
chemical_list: D000336:Aerosols; D000959:Antihypertensive Agents; D011464:Epoprostenol