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Acute amiodarone-induced lung toxicity

L Donaldson1, I S Grant, M R Naysmith

  • 1Department of Anaesthetics, Ninewells Hospital, Dundee, UK.

Intensive Care Medicine
|July 29, 1998
PubMed
Summary

Amiodarone pulmonary toxicity (APT) is a distinct pathological condition in intensive care unit (ICU) patients. Prolonged amiodarone use, especially with high oxygen, may increase risk in patients with acute respiratory distress syndrome (ARDS).

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Area of Science:

  • Pulmonary Pathology
  • Intensive Care Medicine
  • Cardiology

Background:

  • Amiodarone is a widely used antiarrhythmic drug.
  • Amiodarone-induced pulmonary toxicity (APT) is a known but often underdiagnosed complication.
  • Acute respiratory distress syndrome (ARDS) presents a diagnostic challenge in critically ill patients.

Purpose of the Study:

  • To correlate pathological findings of amiodarone pulmonary toxicity (APT) with amiodarone use in patients who died from acute respiratory distress syndrome (ARDS).

Main Methods:

  • Retrospective study of patients dying from ARDS in an Intensive Care Unit (ICU).
  • Review of clinical data and post-mortem histological specimens.
  • Ten patients underwent post-mortem examination over a 3-year period.

Main Results:

  • Seven of ten patients who died from ARDS had received amiodarone.
  • Three patients with amiodarone exposure exceeding 48 hours showed histological evidence of widespread lipoid pneumonia, a pattern of APT.
  • The pathological findings suggest a link between amiodarone use and pulmonary complications in ARDS patients.

Conclusions:

  • Acute amiodarone pulmonary toxicity is a recognizable pathological entity in ICU patients.
  • High oxygen concentrations and pre-existing conditions like ARDS may be risk factors or mask APT.
  • Caution is advised when using amiodarone in patients with ARDS.

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