Medicine of the Future in America

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
Methods
Clinical Series
The study was approved by the institutions Human Subjects Review Committee and each patient or next of kin signed an informed consent. First, we observed the hemodynamic and oxygen transport effects of PGE, on 19 occasions in 18 critically ill surgical patients; 16 were postoperative, one had septic shock and one sustained massive lower GI bleeding from colon cancer. Eleven died, seven survived; eight were male and ten were female. The mean age was 54 years (range: 21 to 95 years). The salient clinical features are listed in Table 1.

Table 1—Clinical Features of the Open Label Series

PatientNo. Age/Sex Diagnosis Surgery Outcome
Part 1: Open Label Indicated
1 30/M Multiple GSW chest, abdomen, pulmonary contusion, ilial perforations, left common iliac artery laceration Ileal resections, iliac artery repair, lower leg fasciotomy S
2 21/M Septic shock from human bite I & D of hand abscess S
3 44/F Blunt trauma, ilial perforation, RUQ abscess Ileal resection, drainage of abscess S
4 84/F Peripheral vascular disease, gangrene right foot Below-the-knee amputation NS
5 85/F Small-bowel obstruction Lysis of adhesions, ileal resection S
6 67/M Rectosigmoid Ca with liver metastases, lower GI bleeding Rectosigmoid resection colostomy NS
7 63/F Sepsis, septic shock, cirrhosis, cholecystitis Cholecystectomy NS
8 69/F Morbid obesity, left ankle fracture, perirectal abscess Diverting colostomy, debridement abdominal wall, drainage of abscess NS
9 82/F Ischemic bowel, septic shock Left hemicolectomy S
10 62/M Bowel obstruction Lysis of adhesions, ileal resection NS
11 49/M Gangrenous gallbladder, abscess Cholecystectomy NS
12 64/F Hodgkins, pelvic mass Control of intra-abdominal hemorrhage NS
Part 2: Open Label: Not Indicated
13 73/F Lower GI hemorrhage, diverticulitis Left hemicolectomy NS
14 40/F Cesarean section, severe eclampsia Cesarean section S
15 45/M Gallstone pancreatitis Cholecystectomy, CD exploration s
16 95/F Perforated duodenal ulcer Graham patch NS
17 25/M SW to chest Thoracotomy, right middle and lower lobectomy NS
18 28/M GSW to abdomen, thigh, fractured iliac wing, transection external iliac artery, ileal perforation Arterial repair, ileal resection NS
Part 3: Randomized to PGE,
19 19/F GSW chest, abdomen, diaphragm, liver, duodenum kidney Exploratory laparotomy, duodenal repair, gastrostomy, kidney repair, diaphragm repair S
20 63/F Ampullary Ca Whipple pancreatectomy s
21 27/M GSW thigh, femur fracture, femoral A&V injury Vein graft to femoral artery and vein s
22 20/M GSW thigh and abdomen, laceration superficial femoral artery, ileal perforation Exploratory laparotomy, ileal resection, vein graft repair of artery s
23 22/M SW to neck Exploration of neck, thoracotomy, repair trachea s
24 28/M GSW to abdomen, chest, leg Exploratory laparotomy, repair duodenum, stomach, ureter, repair liver, pancreas s
25 24/M GSW to back, multiple ileal perforation, colon perforation SB resection, transverse colon resection, colostomy, repair vena cava IV s
26 63/M MVA, BAT, jejunal transection, mesenteric laceration Ligation mesenteric bleeder, jejunal resection s
27 33/M GSW to abdomen Left colectomy, nephrectomy,splenectomy, distal pancreatectomy, left renal artery repair s
28 32/M Upper GI hemorrhage, duodenal ulcer V & A, feeding jejunostomy s
Part 4: Randomized Placebo Group
29 44/M Small-bowel obstruction, perforation rectosigmoid diverticula Exploratory laparotomy, lysis of adhesions, repair ileal tear, sigmoid resection, colostomy s
30 36/M MVA, thoracic aortic aneurysm Resection of aneurysm, prosthetic graft NS
31 33/F GSW thigh, buttocks, femur head; rectal and uterus lacerations Colon resection, colostomy, hysterectomy s
32 20/M MVA, transection head of pancreas and duodenum, avulsion of common bile duct Whipple pancreaticoduodenectomy s
33 38/M Perforation of gastric ulcer, peritonitis Graham patch s
34 37/M GSW abdomen, liver laceration Ligation of hepatic veins, repair of bile duct, liver s
35 35/F Sepsis Cholecystostomy s
36 69/F Upper GI hemorrhage, gastric ulcer wing, transection external iliac artery, ileal perforation V & P, gastrotomy s
37 59/F MVA, BAT, ruptured bladder, pelvic fracture, rib fracture, pulmonary contusion Bladder repair, fixation of pelvic fracture NS
38 57/M Ca of rectum s
This entry was posted in Prostaglandin E1 and tagged critically ill surgical patients, exploratory laparotomy, hemodynamic oxygen transport, oxygen therapy.
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