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Acute lung injury and acute respiratory distress syndrome

2007; Elsevier BV; Volume: 370; Issue: 9585 Linguagem: Inglês

10.1016/s0140-6736(07)61182-9

1474-547X

Chaker Ben Salem, Houssem Hmouda, Kamel Bouraoui,

Poisoning and overdose treatments

In panel 1 of their Review,1Wheeler AP Bernard GR Acute lung injury and the acute respiratory distress syndrome: a clinical review.Lancet. 2007; 369: 1553-1565Summary Full Text Full Text PDF PubMed Scopus (659) Google Scholar Arthur Wheeler and Gordon Bernard list the causes of acute lung injury. Among drug-related causes, only overdoses of salicylates and narcotics are cited. Yet the list of drug-related causes is extensive.2Ben-Noun L Drug-induced respiratory disorders: incidence, prevention and management.Drug Saf. 2000; 23: 143-164Crossref PubMed Scopus (48) Google Scholar Non-cardiogenic pulmonary oedema has been seen in relation to hydrochlorothiazide, antineoplastic agents, tocolytic medications, and several other drugs.3Lee-Chiong Jr, T Matthay RA Drug-induced pulmonary edema and acute respiratory distress syndrome.Clin Chest Med. 2004; 25: 95-104Summary Full Text Full Text PDF PubMed Scopus (46) Google Scholar, 4Solar M Ceral J Kvasnicka J Hydrochlorothiazide induced pulmonary edema—a rare side effect of common diuretic drug.Int J Cardiol. 2006; 112: 251-252Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar Gemcitabine, amiodarone, nitrofurantoin, cytarabine, and infliximab have been implicated as possible causes of acute respiratory distress syndrome.2Ben-Noun L Drug-induced respiratory disorders: incidence, prevention and management.Drug Saf. 2000; 23: 143-164Crossref PubMed Scopus (48) Google Scholar, 3Lee-Chiong Jr, T Matthay RA Drug-induced pulmonary edema and acute respiratory distress syndrome.Clin Chest Med. 2004; 25: 95-104Summary Full Text Full Text PDF PubMed Scopus (46) Google Scholar The exact mechanism of pulmonary toxicity has not been elucidated for most drugs. Acute lung injury and acute respiratory distress syndrome are common clinical manifestations of drug-induced lung injury.3Lee-Chiong Jr, T Matthay RA Drug-induced pulmonary edema and acute respiratory distress syndrome.Clin Chest Med. 2004; 25: 95-104Summary Full Text Full Text PDF PubMed Scopus (46) Google Scholar The possibility of such must be kept in mind, and systematically evoked, particularly if the cause of lung injury is not evident. Diagnosis is based on a history of drug exposure with a temporal relation between the introduction of the drug and the onset of symptoms, and on exclusion of other causes of acute lung injury. Clinical management is based on timely withdrawal of the offending drug and supportive measures. Symptoms resolve quickly, although fatalities have been reported with some drugs. Corticosteroids might be necessary in some cases.2Ben-Noun L Drug-induced respiratory disorders: incidence, prevention and management.Drug Saf. 2000; 23: 143-164Crossref PubMed Scopus (48) Google Scholar Use of potentially harmful drugs (ie, acute-lung-injury inducers) in patients with acute respiratory distress syndrome warrants caution and awareness. Indeed, many researchers suggest the avoidance of amiodarone for treatment of supraventricular and ventricular arrhythmias in case of severe respiratory failure, and after thoracic or non-thoracic surgery.5Van Mieghem W Coolen L Malysse I et al.Amiodarone and the development of ARDS after lung surgery.Chest. 1994; 105: 1642-1645Crossref PubMed Scopus (183) Google Scholar We declare that we have no conflict of interest. Acute lung injury and acute respiratory distress syndrome – Authors' replyWe agree with Michael Eisenhut that, along with numerous other actions, β agonists increase fluid clearance from the lung, although we are unaware of data to suggest that fluid clearance is “equally important” to the processes favouring oedema formation. Although β agonists have been shown to improve physiological variables, and in uncontrolled studies are associated with improved clinical outcomes, improvements in important clinical outcomes (eg, survival or ventilator time) in placebo-controlled trials remain unproven. Full-Text PDF