[HSF] Amiodarone, ARDS, and the Pump

[Mark Levinson]

On Jul 19, 2007, at 8:03 PM, Hgrmd at aol.com wrote:

> Dave,
>   I've heard about the increased incidence of ARDS with amio given  
> on  pump,
> but have really never identified it in one of my patients.  This  
> is  despite
> the fact that I use it liberally during my valve cases.  In fact,   
> I've now
> largely substituted it for lidocaine.  Am I wrong?  What is  the  
> real incidence
> of clinically significant ARDS produced by amio given during  a  
> pump run?
>

Hal:

I think this entity is real.      However, cause and effect is hard  
to prove.

I have had at least 3 cases of acute ARDS after starting IV  
Amiodarone, either
during the surgery or within a few hours.    In one dramatic case,  
the patient
was a lifetime non-smoker undergoing uneventful MVR + Pulm Vein  
isolation.  First CXR totally clear
and gas exchange normal.    Within 12 hours of starting Amio, she was  
on 100% BiPap with
ARDS on CXR.   I stopped the Amio and the process resolved in about 4  
days.

Yes, there could be other causes too.    But in this one case,  
nothing else stood out.
I have seen 2 other similar cases.     I wish I could say they were  
all definately drug
induced, but the absence of another cause leaves me wondering.

I have also had a death from amio induced pancyotpenia which has also
been reported.    its a drug that bears watching....

Mark


Mark M. Levinson, MD
Founder, Editor-in-Chief,
The Heart Surgery Forum
WWW: <http://www.hsforum.com>
Email: <mmLevinson at hsforum.com>