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Category Archives: Prostaglandin E1

Effects of Prostaglandin E1 in Postoperative Surgical Patients with Circulatory Deficiency: Discussion (2)

These findings may be explained by previous observations that PGEt overcomes the platelet aggregation and neutrophil margination stimulated by thromboxane. These events were thought to occur in the pulmonary circulation, but the present study indicates that these actions also may take place in the systemic circulation, that is, the infused PGE, not taken up on transit through the lungs may similarly affect the systemic and coronary circulations to improve overall blood flow and tissue perfusion. buy flovent inhaler
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Effects of Prostaglandin E1 in Postoperative Surgical Patients with Circulatory Deficiency: Discussion (1)

Effects of Prostaglandin E1 in Postoperative Surgical Patients with Circulatory Deficiency: Discussion (1)The effects of PGE i on the pulmonary and systemic circulation were observed in critically ill surgical patients with evidence of circulatory impairment after maximal volume loading in a protocol for surgical patients prior to the development of ARDS. Traditionally, studies have evaluated physiologic effects of therapeutic agents given to patients in shock or other circulatory deficiencies; the physiologic effects are then compared with the biologic outcome, morbidity and mortality. This approach tacitly evaluates the agent tested as though its action were sufficient, in and of itself, to reverse an otherwise morbid course and thereby improve outcome.

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Effects of Prostaglandin E1 in Postoperative Surgical Patients with Circulatory Deficiency: Results

Open Label Studies
Data summarizing the major hemodynamic and oxygen transport effects of the first series are shown in Table 2. There was a significant increase in CO with slight reduction in blood pressure and elevation of HR. Mean pulmonary arterial pressure, PaOP and both pulmonary and systemic vascular resistance decreased, while Do2 and Vo2 increased. The oxygen extraction increased slightly.
In general, patients who were elderly and had previous cardiac problems as well as those given the drug three or more days postoperatively had fewer improvements than those who were studied in the early postoperative period. Table 2 compares the responses of the patients studied early with those studied three or more days postoperatively. buy ventolin inhalers
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Effects of Prostaglandin E1 in Postoperative Surgical Patients with Circulatory Deficiency (5)

Effects of Prostaglandin E1 in Postoperative Surgical Patients with Circulatory Deficiency (5)To discontinue the drug at the end of the study period, the infusion was tapered off over a 2-h period. buy cipro
Pnospectively Randomized Dials: Fluid volume was routinely given until either the optimal therapeutic goals were achieved or PaOP greater than 15 mm Hg was reached. If optimal goals were not achieved by the time PaOP reached 15 mm Hg, the patient was considered eligible for this study. After informed consent was obtained, a card was removed from a numbered sealed opaque envelope, previously prepared by an outside person from a random number table. This card determined if the patient would receive PGE, or a placebo. The PGE, or placebo was given as described previously for the open-label trials; the physicians responsible for patient care and making measurements were blinded to the agent being given.
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Effects of Prostaglandin E1 in Postoperative Surgical Patients with Circulatory Deficiency (4)

Experimental Design and Protocol
Open Label Trials: Fluid therapy first was given in vigorous amounts in attempts to reach optimal Cl, Do2 and Vo2 values without increasing wedge pressures greater than 15 mm Hg; these optimal supranormal values had been determined empirically from a large series of critically ill postoperative survivors. Usually colloids were used because they were found to be more effective than crystalloids in reaching and maintaining the optimal therapeutic goals. If there were an inadequate circulatory response or optimal flow and oxygen transport values were not achieved, PGE, was given as a trial of therapy. flovent inhaler

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Effects of Prostaglandin E1 in Postoperative Surgical Patients with Circulatory Deficiency (3)

Effects of Prostaglandin E1 in Postoperative Surgical Patients with Circulatory Deficiency (3)Second, we studied 20 patients in a prospective randomized clinical trial. Patients were selected for study if after adequate volume therapy indicated by PaOP greater than 15 mm Hg in the immediate postoperative period they did not achieve the median cardiorespiratory values previously observed in survivors of high-risk postoperative patients; ie, CI>4.5 L/mi*m2, Do2 >600 ml/ minm and Vo, >170 ml/minm. buy birth control online
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Effects of Prostaglandin E1 in Postoperative Surgical Patients with Circulatory Deficiency (2)

Then a prospective randomized placebo-controlled trial was undertaken to evaluate the effectiveness of this drug in the early postoperative period. The aim of the present study differed in experimental design from the previous multi-institutional study of Bone et al in that we volume-loaded the patients with colloids to achieve stable PaOP values greater than 15 mm Hg under the assumption that the primary circulatory defect was poor tissue perfusion from maldistributed flow and local ischemia. It is postulated that the effects of PGE, may be transitory if the primary circulatory defect is not also corrected. ventolin 100 mcg
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Effects of Prostaglandin E1 in Postoperative Surgical Patients with Circulatory Deficiency (1)

Effects of Prostaglandin E1 in Postoperative Surgical Patients with Circulatory Deficiency (1)Previous studies of PGE, in postoperative ARDS showed pulmonary vasodilation with reduced pulmonary artery pressure and PaOP followed several hours later by improved blood gas values and reduced pulmonary right-to-left shunt; this was interpreted as evidence that the initial primary PGE, effect in early postoperative ARDS was pulmonary vasodilation evidenced by reduced pulmonary vascular resistance, pulmonary arterial pressure, and PaOP. These findings were associated with improved distribution of flow and improved lung function. An unexpected finding was increased CO, Do2, and Vo2, suggesting that PGE, also had an appreciable effect on the systemic circulation. Holcroft et al2 demonstrated reduced mortality in patients given PGE,. However, Bone et al in a multi-institutional study found no improvement in mortality or morbidity. In ARDS patients given PGI2, Bihari and Tinker showed increased Vo2 with increasing values of Do2 in survivors but not in those who died. proventil inhaler
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