Right-heart catheterization was performed in these three patients and showed normal pulmonary wedge pressures and normal cardiac output on each occasion. Treatment with amiodarone was stopped after a total dose of 2,150 mg in the first, 3,750 mg in the second, and 3,350 mg in the third patient.
Plasma levels of amiodarone and desethylamio-darone (Table 2) were similar and within expected limits in all pneumonectomy patients of the amiodarone group, whether they developed ARDS or not.
Other treatment of these patients consisted of artificial ventilation, fluid restriction, diuretics, meth-ylprednisolone for 24 h, and hemodynamic support with dobutamine and dopamine.
The first two patients died during the course of their ARDS because of intractable hypoxemia despite ventilatory treatment with a high fraction of inspired oxygen (FI02) and positive end-expiratory pressure (PEEP), and the third one recovered.
An autopsy was performed on patient 1 and showed typical characteristics of ARDS in the remaining left lung. Canadian pharmacy mall The macroscopic picture was that of a red-blue heavy lung and elastic consistency not collapsing on incision. On microscopic examination, an elastoid degeneration of the lung parenchyma was seen with lymphocytic reaction and hyaline membranes.
Clinical and hemodynamic data of these three patients are summarized in Table 3; all patients were men and none had hepatic or renal dysfunction.
From January 1987 until September 1991, a total of 310 lobectomies and 108 right-sided and 134 leftsided pneumonectomies were performed. The results are summarized in Table 4. The incidence of atrial fibrillation varied from 16 percent in the lobectomy group to 23 percent after left-sided pneumonectomy. The overall incidence of ARDS was 11 percent in the patients treated with amiodarone compared with 1.8 percent in the nonamiodarone group, a difference which is highly significant (x2 33; p<0.0001).
Table 2—Plasma Levels (fig/L) of Amiodarone (A) and Desethylamiodarone (D) in Patients With (Y) and Without (N) ARDS
|Drug||ARDS||12 ht||24 h||36 h||48 h||60 h|
|A||N||1,587 ±1,094||1,451 ±159||2,069 ±561||2,188 ±485||2,483 ±822|
|A||Y||1,136 ±480||1,146|||1,562 ±176||1,635 ±99||2,261 ±341|
|D||N||144± 116||157±51||248 ±104||216 ±34||293 ±99|
|D||Y||71 ±49||104|||251 ±130||190± 12||189 ±63|
Table 3—Clinical Data and Lung Injury Score (7) in the 3 Patients With ARDS After Amiodarone Therapy
|Patient||No. 1||No. 2||No. 3|
|FEVi, % of pred||90||86||95|
|Deo, % of pred||81||111||73|
|Chest roentgenogram score||4||3||4|
|Lung injury score||3||3||3|
|Cardiac output, L/min||6.5||4||5.5|
|Mean pulmonary artery pressure, mm Hg||29||23||34|
|Pulmonary capillary wedge pressure, mm Hg||13||5||9|
|Pulmonary vascular resistance, dynes s cm||200||360||360|
|Systolic arterial pressure, mm Hg||86||122||106|
|Systemic vascular resistance, dynes s cm”||800||1,300||1,440|
|Amiodarone total dose, mg||2,150||3,750||3,350|
|Amiodarone plasma levels, Mg/L||1,476||2,020||2,503|
|Artificial ventilation, d||1||8||5|
Table 4—Retrospective Analysis of the Incidence of Atrial Fibrillation (AF), Amiodarone Administration (AM), Total Number of ARDS Cases, and Concomitant AM Followed by the Occurrence of ARDS After Right-Sided Pneumonectomy (RP), Left-Sided Pneumonectomy (LP), and Lobectomy (LOB) From January 1987 until September 1991
|No.||AF (%)||AM (%)||ARDS (%)||AM + ARDS|
|RP||108||21 (19.4)||13 (12)||8(7.4)||1|