Abstract
The importance of pulmonary vascular control in the clinical manifestation of acute lung injury (ALI) was recognized in early clinical and experimental studies of the acute respiratory distress syndrome in adults (ARDS). Thus, pulmonary hypertension was shown to be an important early feature of ARDS with adverse prognostic significance. Persistant raised pulmonary vascular resistance (PVR) was found to be associated with structural changes in the pulmonary vasculature. Lastly, the profound loss of pulmonary vascular reactivity was found to contribute significantly to adverse ventilation(V)/perfusion (Q) mismatch, contributing significantly to the refractory hypoxemia that characterizes the clinical syndrome [1]. In this chapter, a brief review of pulmonary vasomotor control in the normal and acutely injured lung will be followed by a summary of current clinical practice in this area. The contribution of the increase in our scientific understanding of the pulmonary vasomotor control to existing and potential new therapeutic interventions will also be summarized.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Dantzker DR, Brook CJ, Dehart P, Lynch JP, Weg JG (1979) Ventilation-perfusion distributions in the adult respiratory distress syndrome. Am Rev Respir Dis 120: 1039–1052
Liu SF, Crawley DG, Barnes PJ, Evans TW (1991) Endothelium-derived relaxant factor modulates hypoxic pulmonary vasoconstriction in isolated blood-perfused rat lungs. Am Rev Respir Dis 143: 32–37
Lui SF, Dewar A, Crawley DE, Barnes PJ, Evans TW (1992) Effects of tumour necrosis factor on hypoxic pulmonary vasoconstriction and endothelium-dependent relaxation in the blood-perfused rat lung. J Appl Physiol 72: 1044–1049
Crawley DE, Zhao L, Giembycz MA, et al (1992) Mechanism for the impairment of endothelium-dependent vasodilatation in rats exposed chronically to hypoxia. Am J Physiol 263: L325–L332
Griffiths MJD, Curzen NP, Evans TW (1994) Nitric oxide synthase inhibitors in septic shock. Clin Intensive Care 5: 29–36
Radermacher P, Huet Y, Pluskwa F, Herigault R, Teisseire B, Lamaire F (1988) Comparison of ketanserin and sodium nitroprusside in patients with severe ARDS. Anesthesiology 68: 152–157
Melot C, Naeije R, Mols P, Hallemans R, Lejeune P, Jasper N (1987) Pulmonary vascular tone improves pulmonary gas exchange in the adult respiratory distress syndrome. Am Rev Respir Dis 136: 1232–1236
Silverman HJ, Slotman G, Bone RC, et al (1990) Effects of prostaglandin E1 on oxygen delivery and consumption in patients with the adult repiratory distress synydrome. Results from the prostaglandin E1 multicentre trial. Chest 98: 405–410
Metz C, Sibbald WJ (1991) Anti inflammatory therapy for acute lung injury. A review of animal and clinical studies. Chest 100: 1110–1119
Finck MP, O’Sullivan BP, Menconi MJ, et al (1993) A novel leukotriene B-receptor antagonist in endotoxin shock: A prospective, controlled trial in a porcine model. Crit Care Med 21: 1825–1837
Steinberg SM, Rodriguez JL, Bitzer LG, Rhee JW, Kelley KA, Flint LM (1990) Indomethacin treatment of human adult respiratory distress syndrome. Circulatory Shock 30: 375–384
Bernard GR, Reines HD, Metz CA, et al. (1988) Effects of a short course of ibuprofen in patients with severe sepsis. Am Rev Respir Dis 137: A138 (Abst)
Leeman M, Boeynaems JM, Degaute JP, Vincent JL, Kahn RJ (1985) Administration of dazoxiben, a selective thromboxane synthetase inhibitor, in the adult respiratory distress syndrome. Chest 87: 726–730
Akerasereenont P, Mitchell JA, Thiemermann C, Vane JR (1995) Relative potency of non-steroid anti-inflammatory drugs as inhibitors of cyclooxygenase-1 or cyclooxygenase-2. Br J Pharmacol (in press)
Morgan JM, McKormack DG, Griffiths MJD, Morgan CJ, Barnes PJ, Evans TW (1991) Adenosine as a vasodilator in primary pulmonary hypertension. Circulation 84: 1145–1149
Haywood GA, Sneddon JF, Bashir Y, Jennison SH, Gray HH, McKenna WJ (1992) Adenosine infusion for the reversal of pulmonary vasoconstriction in biventricular failure. A good test but a poor therapy. Circulation 86: 896–902
Wysocki M, Delclaux C, Roupie E, et al (1994) Additive effect on gas exchange of inhaled nitric oxide and intravenous almitrine bimesylate in the adult respiratory distress syndrome. Intensive Care Med 20: 254–259
Zapol WM, Rimar S, Gillis N, Marietta M, Bosken CH (1994) Nitric oxide and the lung. Am J Respir Crit Care Med 149: 1375–1380
Frosteil CG, Blomqvist H, Hedenstierna G, Lundberg J, Zapol WM (1993) Inhaled nitric oxide selectively reverses human hypoxic pulmonary vasoconstriction without causing systemic vasodilation. Anesthesiology 78: 427–435
Gerlach H, Pappert D, Lewandowski K, Rossaint R, Falke KJ (1993) Long-term inhalation with evaluated low doses of nitric oxide for selective improvement of oxygenation in patients with adult respiratory distress syndrome. Intensive Care Med 19: 443–449
Puybasset L, Rouby JJ, Mourgeon E, et al (1994) Inhaled nitric oxide in acute respiratory failure: Dose-response curves. Intensive Care Med 20: 319–327
Wessel DL, Adatia I, Thompson JE, Hickey PR (1994) Delivery and monitoring of inhaled nitric oxide in patients with pulmonary hypertension. Crit Care Med 22: 930–938
Walmrath D, Schneider T, Pilch J, Grimminger F, Seeger W (1993) Aerosolised prostacyclin in adult respiratory distress syndrome. Lancet 342: 961–962
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1995 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Shephard, J., Brett, S., Evans, T.W. (1995). Therapeutic Manipulation of the Pulmonary Circulation in Acute Lung Injury. In: Vincent, JL. (eds) Yearbook of Intensive Care and Emergency Medicine. Yearbook of Intensive Care and Emergency Medicine, vol 1995. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-79154-3_25
Download citation
DOI: https://doi.org/10.1007/978-3-642-79154-3_25
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-58256-4
Online ISBN: 978-3-642-79154-3
eBook Packages: Springer Book Archive