Amiodarone and the Development of ARDS After Lung Surgery: Conclusion

Amiodarone and the Development of ARDS After Lung Surgery: ConclusionDirect toxic injury of lung parenchymal cells by amiodarone, regardless of the specific mechanisms, can trigger a repair process with widespread deposition of collagen that further deranges the alveolar capillary structures. Additionally, amiodarone may directly induce fibroblast replication in vitro, potentially facilitating the fibrotic response to amiodarone-mediated injury. Buy proventil in detail As pulmonary fibrosis occurs, gas exchange is further impaired and the chance for reversibility of the disorder is significantly lessened. In part, different mechanisms of toxicity may relate to differing clinical presentations. On the other hand, it is possible that toxicity from amiodarone or desethylamio-darone represents a spectrum of toxic reactions that are interrelated and interdependent, and that the major factor responsible for differing clinical presentations is the genetically determined response of the individual.
Acute pulmonary toxicity has been described after both cardiac and noncardiac operations in patients receiving preoperative amiodarone therapy. Consistently, the pulmonary abnormalities appear 1 to 4 days after extubation and progress rapidly with a high mortality rate. The mechanism by which surgery may initiate this acute lung reaction to amiodarone is not known; cardiopulmonary bypass, peroperative oxygen toxicity, congestive heart failure, and superimposed infection have all been proposed.
In our three postpneumonectomy patients or in other patients with acute amiodarone-related pulmonary toxicity after noncardiac surgery, cardiopulmonary bypass or congestive heart failure cannot be implicated.
To our knowledge, development of ARDS in conjunction with postoperative initiation of amiodarone therapy has not been previously reported. On the contrary, intravenous prophylactic administration of amiodarone in doses comparable with those used in our study were reported safe and effective in patients undergoing coronary artery bypass surgery. Serial plasma levels of amiodarone and desethylamiodarone are summarized in Table 2. None exceeded the accepted therapeutic range.
It is well known that ARDS occurs more frequently after right-sided pneumonectomy compared with other types of lung surgery. The pathogenesis is unclear and several possible mechanisms have been proposed.

This entry was posted in ARDS and tagged amiodarone therapy, arrhythmia, lung surgery, pneumonectomy, pulmonary toxicity.