ABSTRACT
Summary Objective: The aim of this study was to evaluate the effect of rhubarb on extravascular lung water (EVLW) in patients with acute respiratory distress syndrome (ARDS). Method: A total of 80 patients with ARDS were randomly divided into a treatment group (40 cases) and control group (40 cases). Patients in the treatment group received rhubarb (30.0 g/d) and patients in the control group received conventional therapy for seven consecutive days. Extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were determined using pulse contour cardiac output (PiCCO) technology, and the oxygenation index was measured by blood gas analysis at baseline and on days 3, 5 and 7 after treatment. Results: The oxygenation index was higher and the levels of EVLWI and PVPI were lower after treatment in the two groups; however, these indexes showed significant differences on the 5th and 7th days after rhubarb treatment compared with the results in the control group (p<0.05). Conclusion: Rhubarb can decrease EVLWI and PVPI, and improve oxygenation in patients with ARDS.
Subject(s)
Humans , Male , Female , Adult , Aged , Young Adult , Respiratory Distress Syndrome/drug therapy , Rheum/chemistry , Drugs, Chinese Herbal/therapeutic use , Extravascular Lung Water/drug effects , Oxygen/physiology , Pulmonary Edema/drug therapy , Respiratory Distress Syndrome/physiopathology , Time Factors , Blood Gas Analysis , Capillary Permeability/drug effects , Capillary Permeability/physiology , Cardiac Output/drug effects , Cardiac Output/physiology , Extravascular Lung Water/physiology , Reproducibility of Results , Analysis of Variance , Treatment Outcome , Lung/drug effects , Lung/physiopathology , Middle AgedABSTRACT
Meconium aspiration syndrome causes respiratory failure after birth and in vivo monitoring of pulmonary edema is difficult. The objective of the present study was to assess hemodynamic changes and edema measured by transcardiopulmonary thermodilution in low weight newborn piglets. Additionally, the effect of early administration of sildenafil (2 mg/kg vo, 30 min after meconium aspiration) on this critical parameter was determined in the meconium aspiration syndrome model. Thirty-eight mechanically ventilated anesthetized male piglets (Sus scrofa domestica) aged 12 to 72 h (1660 ± 192 g) received diluted fresh human meconium in the airway in order to evoke pulmonary hypertension (PHT). Extravascular lung water was measured in vivo with a PiCCO monitor and ex vivo by the gravimetric method, resulting in an overestimate of 3.5 ± 2.3 mL compared to the first measurement. A significant PHT of 15 Torr above basal pressure was observed, similar to that of severely affected humans, leading to an increase in ventilatory support. The vascular permeability index increased 57 percent, suggesting altered alveolocapillary membrane permeability. Histology revealed tissue vessel congestion and nonspecific chemical pneumonitis. A group of animals received sildenafil, which prevented the development of PHT and lung edema, as evaluated by in vivo monitoring. In summary, the transcardiopulmonary thermodilution method is a reliable tool for monitoring critical newborn changes, offering the opportunity to experimentally explore putative therapeutics in vivo. Sildenafil could be employed to prevent PHT and edema if used in the first stages of development of the disease.
Subject(s)
Animals , Humans , Infant, Newborn , Male , Extravascular Lung Water/drug effects , Hypertension, Pulmonary/prevention & control , Meconium Aspiration Syndrome/drug therapy , Piperazines/administration & dosage , Sulfones/administration & dosage , Vasodilator Agents/therapeutic use , Animals, Newborn , Disease Models, Animal , Lung/drug effects , Lung/pathology , Meconium Aspiration Syndrome/pathology , Purines/administration & dosage , Sus scrofa , Time Factors , Thermodilution/methodsABSTRACT
Introducción. La retención del líquido pulmonar (RLP) es una patología benigna relativamente frecuente, que se presenta principalmente en niños de término, nacidos por cesárea y cuya fisiopatología consiste en retardo en la reabsorción del líquido pulmonar que ocurre en las primeras horas de vida y que puede dar manifestaciones clínicas variables. La furosemida administrada en bolos no ha tenido resultados alentadores en acelerar el proceso de reabsorción, en este estudio se aplicó el medicamento en infusión continua y se observó la evolución y duración de esta enfermedad. Material y métodos. Se estudiaron 40 recién nacidos de término con diagnóstico clínico y radiológico de RLP y se formaron dos grupos: el A con diurético en infusión continua y el B con manejo convencional. Resultados. No hubo diferencias significativas en cuanto a sexo, vía de nacimiento, calificación de Apgar, edad gestacional y peso al nacer. Se evaluaron electrolitos séricos pre y post.tratamiento en el grupo A, aunque estadísticamente no significativa. Fue más rápida la resolución en el grupo que se administró la infusión de furosemide (13.9 ñ 7.5 vs 23.6 ñ 10.3, P < 0.001). Conclusión. Aunque en este trabajo se comprobó resolución más rápida de la patología, ésta es de sólo 10 horas por lo que no se considera la aplicación de furosemide en forma rutinaria