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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
Randomized Series
Figures 1 and 2 compare the pattern of hemodynamic and oxygen transport variables in patients given PGE, and the placebo. In those given PGE, there were significant reductions in pulmonary artery pressure and PVRI as well as increases in Cl, SI, Do2, and Vo2. By contrast, there were no significant changes in the placebo group except elevation of PVRI.
There were two deaths in the placebo group and no deaths in the PGE, group and there were more organ failures in the control group (Table 3). However, there were no differences in the incidence of nonshock-related complications commonly encountered in postoperative patients.

Table 2—Changes in Hemodynamic and Oxygen Transport Variables from Baseline after PGEl Infusion at Various Doses Gwen by Open Label in the Early and Late Postoperative Period and in the Entire Series

10 ng/kg*min 20 ng/kg*min 40 ng/kg*min 60 ng/kg*min 2 h Later
HR, beats per minute All 0.6 ±3.4 2.7± 1.1 6.0±1.3f 0.3±2.7 8.0 ±2
Early — 0.3±2.2 1.3± 1.2 5.4±2.1 -1.0 5.0 ±2
. Late 2.0 ± 10 3.6± 1.6 6.3± 1.7 2 10.5 ±4
MAP, mm Hg All -5.4 ±2.4 -4.9 ±2.4 — 5.9±3.2 – 10 ±7.1 — 8.6±3
■ Early -3.7 ±3.2 — 2.6± 1.9 —0.8±4.1 -1 — 0.2±2
1 I Late — 8±4 —6.4±3.7 — 8.8±4.4 -14 -15 ±5
MPAP, mm Hg 1 r aii —1.8± 1.2 — 3.6± 1 — 4.5± 1.8 -7.3 ±3.4 — 8.7±2
I Early — 2.3± 1.2 — 2.6± 1.3 — 4.8±3.9 5 —3.6±3
1 I Late —1±3 —4.2± 1.5 — 4.3±1.9 — 8.5±5.5 —13 ±3
PaOP, mm Hg All 1± 1.3 —0.9±6 — 2.9± 1.3 — 3.3± 1.9 — 5.7±2
Early -0.3±0.7 -0.3 ±0.8 — 4±2.4 -2 —1.6±2
. Late 3.0 ±3 —1.3±9 — 2.2± 1.5 — 4.0±3 —9.2±3
Cl, L/min*m2 1 r ah 0.08 ±0.35 0.15±0.11 0.51±0.12t 0.68 ±.06f 0.69±.20
I Early 0.3 ±0.42 0.01 ±0.22 0.44 ±0.13f 0.75 1.02 ±.27
l 1 Late 0.72 ±0.07 0.24±0.11 0.55±0.17f 0.65 ±.08f 0.40 ±0.27
SI, ml/m* All 0.9 ±3.1 0.5 ±0.9 2.45 ±1 7.4±1.5t 3.0 ±2
Early — 2.7±3 —0.3± 1.8 -2.2±0.07| 10.4 7.6±2
. Late 6.3±4.1 1.1±0.8 2.6± 1.6 5.9±.32t 0.8 ±2
SVRI, r ah -237 ±141 -171 ±61 -241 ±99 — 520 ±205 — 231 ± 1
dynes*s \ * Early — 8±28 — 73 ± 74 -21 ±100 -279 —175 ± 7
cm^M* 1 I Late — 579 ± 3 -334 ±86f —364±130t — 641 ±287 — 288 ±2
PVRI, ’ All -61 ±32 -80 ±27 —81 ±38 —195 ±156 —114±4
dynes*s ■ Early —13 ±20 — 71 ±38 —55 ±37 -147 —98±3
cm^M* . Late 132 ±14 — 85±38 -95 ±56. -218 ±267 -126 ±7
SaOj, % 1 f All 0.9± 1.1 -0.9 ±0.3 — 2.5±7f — 5.6±7f -2.9 ±.9
| Early 1.3± 1.9 —0.6±0.5 — 3.7± 1.2t -5.3 — 3.5± 1.8
l I Late 0.4 ±0.6 —1.1±0.5 —1.8±0.8 — 5.8± 1.3t -2.4 ±.7
Sv02, mm Hg ‘ All — 0.1 ±4.4 —0.5± 1.3 — 2.4± 1.6 0.5±4.8 —1.7±2
Early — 0.3± 1.5 —1.3±1.5 — 6.3 ±3.1 -2.8 —0.7±3
. Late 0.2 ±13.6 + 1.9±6.2 — 0.3± 1.4 — 6.1 ±8.1 — 2.5±2
Do2, ml/min*m2 All 16 ±42 14 ±18 58± 15 70 ± 17f 59 ±25
Early — 58 ±62 —17 ± 40 20 ±20 72 ± 18f 80±2
. Late 98±6 24± 16 67 ± 19f 69±17t 42 ±3
Vo2, ml/min*m2 ’ All 12 ±27 1±7 14 ±8 27 ±22 12 ±1
Early 1 ±20 6± 10 33± 16 40±5t 19 ±2
. Late 29 ±74 — 1 ±9 4±8 21 ±37 6±1
02ex, % ’ All 0.9±4.5 — 0.4± 1.3 0.2± 1.3 1.0±4.5 — 0.9 ±2
Early 1.5±3.2 0.7± 1.7 3.1±2.7 0.1 — 2.3 ±4
. Late 0.1 ±13.2 —1.2±1.8 —1.4± 1.3 1.4±7.7 0.2 ±2

Table 3—Mortality and Morbidity Data

Control Group PGE, Group
Deaths 2 0
Organ failures
ARDS 3 1
Myocardial infarction 1
Renal failure 1
Coagulopathy 1
Hepatic failure 1
Complications
Wound infection 1
Sepsis 2 2
Pulmonary edema 1
Anastomatic leak with abscess 1

Figure-1

Figure 1. Hemodynamic responses to PGE, and placebo. Mean arterial pressure, mean pulmonary arterial pressure and PaOP (wedge pressure) changes before and at various dosages of PGE, (solid line) compared with placebo (dotted line). Dots indicate mean values; vertical bars indicate SE.

Figure-2

Figure 2, (at left). Resistance and oxygen transport responses to PGE, and placebo. Systemic vascular resistance, pulmonary vascular resistance, Do and Vo2 changes before and at various dosages of PGE, (solid line) compared with placebo (dotted line). Dots indicate mean values; vertical bars indicate SE.

This entry was posted in Prostaglandin E1 and tagged critically ill surgical patients, exploratory laparotomy, hemodynamic oxygen transport, oxygen therapy.
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