Gas exchange and pulmonary haemodynamic responses to fat emulsions in acute respiratory distress syndrome

J. R. Masclans, R. Iglesia, B. Bermejo, M. Picó, R. Rodriguez-Roisin, M. Planas

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    Abstract

    Objective: To investigate the gas exchange and pulmonary haemodynamic responses to two different intravenous fat emulsions in patients with acute respiratory distress syndrome (ARDS). Design: Prospective, randomized, double-blind, placebo-controlled study. Setting: Intensive care unit in a university-affiliated hospital. Patients: 21 patients with ARDS [mean age, 57 ± 3 (SEM) years; Acute Physiology and Chronic Health Evaluation II, 20 ± 3; Murray's score, 2.85 ± 0.12] consecutively admitted. Interventions: Patients were assigned to three groups (n = 7 each): group A (LCT) received long-chain triglycerides (20% LCT), group B (MCT/LCT), medium-chain triglycerides/long-chain triglycerides (20% MCT/LCT: 50/50) and group C placebo (0.9% sodium chloride, NaCl). The infusion was always given at the rate of 2 mg/kg min over a total period of 12 h, with a volume infusion of 500 ml in each group. Measurements: Data were collected before, immediately after and 12 h after infusion ceased. Pulmonary and systemic haemodynamic and gas exchange variables were measured at each time point. Serum triglyceride cholesterol, and non-esterified fatty acids levels were measured. Results: During LCT infusion, cardiac output, oxygen consumption and oxygen delivery increased (all p < 0.05), whereas pulmonary haemodynamics, arterial oxygen tension, mixed venous partial pressure of oxygen and venous admixture ratio remained essentially unaltered. No changes were observed following MCT/LCT infusion. Conclusions: The administration of LCT emulsion given at a slow rate did not alter arterial oxygenation because of the beneficial effect of a high cardiac output, hence offsetting the detrimental effect of increased O2 consumption.
    Original languageEnglish
    Pages (from-to)918-923
    JournalIntensive Care Medicine
    Volume24
    Issue number9
    DOIs
    Publication statusPublished - 19 Oct 1998

    Keywords

    • Acute lung injury
    • Cardiopulmonary interactions
    • Eicosanoids
    • Lipid emulsions
    • Nutritional support
    • Prostaglandins

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