Chest
Volume 91, Issue 3, March 1987, Pages 388-393
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Almitrine in Acute Respiratory Failure: Effects on Pulmonary Gas Exchange and Circulation

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The effects of almitrine administration on pulmonary gas exchange and pulmonary and systemic hemodynamics were assessed in eight patients with severe acute respiratory failure (ARF) secondary to sepsis or shock. A control group of five patients not receiving the drug were submitted to the same protocol. All the patients were sedated, paralyzed, and mechanically ventilated. Measurements were made before (BASELINE), during (ALM 15), at the end of (ALM 30), and at 30 minute intervals after (POSTALM 30, 60, 90, 120) the intravenous (IV) infusion of 0.5 mg/kg body weight of almitrine in 30 minutes. Almitrine produced an increase in PaO2 from 86±14 (BASELINE) to 129±69 (ALM 15) and 129±86 mm Hg (ALM 30). The PaO2 quickly declined after stopping the infusion. The P(A-a)O2 and Q˙Va/ Q˙t decreased with almitrine administration. The Ppa and Q˙t increased transiently at ALM 30. We conclude that IV almitrine improves gas exchange and may be useful in the management of ARE.

Section snippets

Subjects

Ten consecutive patients without a history of previous lung disease, suffering from acute respiratory failure (ARF) secondary to extrapulmonary processes, were studied. The protocol was approved by the Human Research Committee of our institution, and informed written consent was obtained from patients' next-of-kin. Sex, age, and diagnosis of the patients are shown in Table 1. All of them were intubated and mechanically ventilated. Bilateral diffuse pulmonary infiltrates were observed in chest

Results

The etiology of ARF in our patients was shock, sepsis, or both. Massive upper gastrointestinal tract bleeding was present in five patients. Sepsis was always of abdominal origin except in patient 6 who had right humerus osteomyelitis due to Staphylococcus aureus (Table 1). Age in the almitrine group (65.9±14.0 years, mean±SD) was similar to the control group (65.8±14.0 years). Patients were studied between day 1 and 5 from start of mechanical ventilation. Respiratory rate and V˙e were

DISCUSSION

Almitrine was effective in increasing PaO2 in all our patients. The rise was immediate, but in most cases, PaO2 began to decline even before the completion of the infusion. Several mechanisms can account for the improvement in PaO2. An increase in Q˙t in the presence of constant V˙o2 resulted in a rise in PvO2 which could have contributed to the improvement in PaO2. This mechanism is probably responsible for the small variations in PaO2 in patients 3, 7, and 8 at ALM 30, but for the

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  • Cited by (20)

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      2000, Clinics in Chest Medicine
      Citation Excerpt :

      The second trial compared the use of almitrine in ARDS patients with controls, and showed a significant increase in Pa o2, and a reduction in both the Pa o2–PAO2 gradient and venous admixture. Similar results have been reproduced in other small studies.136 The use of almitrine bismesylate with NO has also been investigated.

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    Manuscript received May 1; revision accepted August 20.

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