Prostacyclin-Inhalation in Kombination mit Almitrine zur Therapie des akuten Lungenversagens
The aim of this prospective controlled animal study was to investigate a possible additive effect of combined inhaled prostacycline and intravenous almitrine bismesylate (ALM) on pulmonary ventilation-perfusion ratio in acute lung injury (ALI) compared to inhaled prostacycline or intravenous ALM alone. Experimental ALI was established in all 24 pigs (weighing 30+/-3 kg) by repeated lung lavage. Animals were randomly assigned to receive either 25 ng/kg/min inhaled prostacycline alone, 1 µg/kg/min ALM alone, 25 ng/kg/min inhaled prostacycline in combination with 1 µg/kg/min ALM, or no specific treatment (controls) for 30 min. For each intervention pulmonary gas exchange and hemodynamics were analyzed and ventilation-perfusion distributions were calculated using the multiple inert gas elimination technique (MIGET). The data was analyzed within and between the groups by analysis of variance (ANOVA) for repeated measurements, followed by the Student-Newman-Keuls test for multiple comparison when ANOVA revealed significant differences. All values are expressed as mean +/- standard deviation. In controls, pulmonary gas exchange, hemodynamics and ventilation-perfusion distribution remained unchanged. With prostacycline alone and ALM alone arterial oxygen partial pressure increased while intrapulmonary shunt decreased (p<0.05). Combined prostacycline and ALM also increased arterial oxygen partial pressure and decreased intrapulmonary shunt (p<0.05). When compared to either prostacycline or ALM alone the combined application of both drugs revealed no additional effect in gas exchange or ventilation-perfusion distribution. We conclude that in this experimental model of ALI the combination of 25 ng/kg/min prostacycline and 1 µg/kg/min ALM do not result in an additive improvement of pulmonary gas exchange or ventilation-perfusion distribution when compared to prostacycline or ALM alone.
info:eu-repo/classification/ddc/610, Medizin, ARDS, Prostacyclin, Almitrine, ALI, MIGET
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