Use of Prostacyclin in the Treatment of Sepsis-Induced Organ Failure

Francesco Imperatore, MD, Luigi Maria Borrelli, MD, Giovanni Liguori, MD, Paolo Francesco Marsilia, MD, Francesco Munciello, MD, Luigi Occhiochiuso, MD

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Introduction

We briefly report the case of a patient who had a severe sepsis-induced multiple organ failure (MOF) syndrome and was successfully treated with an intravenous (IV) infusion of prostacyclin.

A 27-year-old man was admitted to our intensive care unit (ICU) for severe thoracic and abdominal trauma. He underwent splenectomy. Two days after surgery, the patient developed a subfrenic abscess, for which laparotomy was repeated.

Three days after the second operation, the patient developed severe, sepsis-induced organ failure, including respiratory, renal, and cardiac failure. The diagnosis of sepsis and MOF was applicable, according to criteria from the literature.[1]

Respiratory failure was managed with sedation (propofol 2 mg/kg/h), orotracheal intubation, and invasive mechanical ventilation (tidal volume 7.5 mL/kg, fractional concentration of oxygen in inspired gas [FiO2] 0.5, respiratory rate 12 breaths per minute, and positive end-expiratory pressure [PEEP]). The trend of PaO2/FiO2 and PEEP requirements are reported in the Table 1 .

Cardiac failure was managed by monitoring invasive arterial and central venous pressure and infusion of catecholamines up to standard doses. The types of catecholamines and the dose regimens are reported in the Table.

Doses of antithrombin III were calculated daily on the basis of laboratory results. Antibiotic therapy was first given empirically and then on the basis of culture test results. With the appearance of organ failure, the patient was treated with IV infusion of prostacyclin up to 10 ng/kg/min.

Three days after beginning prostacyclin therapy, we observed a regression of organ failure starting from the heart. Regression was demonstrated by significant improvement in hemodynamic variables and the reduction in need for catecholamines and ventilation support. Mild kidney failure was managed with furosemide. The trend toward diuresis is reported in the Table.

Prostacyclin therapy was continued until the 5th day, when MOF resolved. Five days later, the patient was transferred from the surgical unit and discharged home after 24 days.

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