Prostacyclin and right ventricular function in patients with pulmonary hypertension associated with ARDS

Abstract

Eight patients who developed pulmonary artery hypertension during the adult respiratory distress syndrome (ARDS) were treated with an infusion of prostacyclin (PGI₂, 12.5–35.0 ng·kg⁻¹·min⁻¹) for 45 min. We examined whether reducing the right ventricular (RV) outflow pressures by PGI₂ infusion would increase the right ventricular ejection fraction (RVEF) measured by thermodilution. PGI₂ reduced the pulmonary artery pressure (PAP) from 35.6 to 29.1 mmHg (p−1·m⁻² (p2·1⁻¹,ppr=0.789, Δ% RVEF=−2.11·ΔPVRI-1.45). Despite an increased venous admixture from 27.8% to 36.9% (p2 remained constant resulting in an increased oxygen delivery from 657 to 894 ml·min⁻¹·m⁻² (p2 increased CI concomitant to improved RV function parameters when baseline RVEF was depressed. Since improved oxygen availability should be a major goal in the management of patients with ARDS PGI₂ may be useful to lower pulmonary artery pressure in ARDS.