Shahla Siddiqui, Salwa Zubair.
Case of inhaled Prostaglandin E1 used to improve hypoxia in ARDS.
J Pak Med Assoc Jan ;54(12):635-6.

A 6 year old (M), known case of acute lymphocytic leukemia (ALL) was admitted with cough for 1 week and shortness of breath for 1 day prior to presentation. He was admitted with a diagnosis of pneumonia based on chest X Ray findings and clinical picture. After two days he required intubation and ICU admission for progressive hypoxemia and bilateral diffuse infiltrates on CXR, in keeping with ARDS. He was sedated and relaxed for his worsening status requiring maximal ventilatory support. He was also started on clarithromycin, Septran and meropenem. On the fourth day, when despite a ventilatory support of 1.0 FiO2 and pressure control ventilation with a peep of 15 cm H20, his Pa02 did not improve more than 49 mmHg (Alveolar – arterial gradient of 450 mmHg), he was placed in a prone position for eight hours / day. He was also started on high dose IV methyprednisolone in accordance with management of ARDS, on day 6. However, his respiratory acidosis and hypoxia continued. His chest xray continued to show a diffuse glass appearance. On day 10, Alprostadil (PGE1) was nebulized over 30 minutes every six hours. The dose used was 5 mcgs in normal saline. Over the next 12-24 hours a marked improvement in oxygenation was seen on his arterial blood gases. His A-a gradient improved, however his CXR remained unchanged. No other parameter (proning, ventilatory support, antibiotics) was changed during the therapy. This improvement in PaO2 was not sustained and drifted down once again, despite increasing the PGE1 nebulisation frequency. He died on day 13 on admission.

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