digoxin and Respiratory-Insufficiency

Topics: Animals; Digoxin; Dopamine; Humans; Lung Diseases, Obstructive; Respiratory Insufficiency; Respiratory Muscles; Theophylline

Topics: Adult; Amino Acids; Cardiac Output; Cardiovascular System; Cells; Digoxin; Energy Intake; Energy Metabolism; Female; Heart Diseases; Humans; Infections; Intubation; Metabolic Diseases; Multiple Organ Failure; Myocardium; Positive-Pressure Respiration; Probability; Respiratory Insufficiency; Vascular Resistance

Upper abdominal surgery has been shown to impair the function of the respiratory muscles. In addition, controversial results have been reported concerning the effect of digoxin on the diaphragm. The aim of this study was to investigate further the mechanism(s) of respiratory muscle dysfunction after cholecystectomy and the effect of digoxin on the impaired respiratory muscle function.. Twenty three patients (four men) were studied before and 48 hours after surgery. Eleven received digoxin and 12 placebo. Respiratory muscle strength was assessed 48 hours after surgery by measuring mouth pressure during maximum static inspiratory (PImax) and expiratory (PEmax) efforts before and after 90 minutes of intravenous administration of 0.25 mg digoxin in a double blind, placebo controlled fashion. In addition, spirometric and pain measurements were performed.. Postoperatively (+48 h) PImax and PEmax decreased significantly (p<0.01) from their preoperative values in both groups by a similar degree. After administration of digoxin or placebo only the digoxin group showed a significant increase in both PImax (p<0.02) and PEmax (p<0.05) with a mean increase of 15% for PImax and 12.3% for PEmax. The mean difference in PImax (DeltaPImax) and PEmax (DeltaPEmax) between the digoxin and placebo groups was 1.01 (95% CI 0.28 to 2.2) and 1.05 (95% CI 0.04 to 2.4), respectively. Estimates of postoperative pain did not differ between the two groups. Spirometric indices showed a similar restrictive defect postoperatively in both groups but did not change after digoxin or placebo.. Digoxin improves the impaired global strength of the inspiratory and expiratory muscles after cholecystectomy and this may be clinically relevant. Muscle contractility could play a part in this impairment.

Topics: Adult; Cholecystectomy; Digitalis Glycosides; Digoxin; Double-Blind Method; Female; Forced Expiratory Volume; Humans; Male; Middle Aged; Respiratory Insufficiency; Respiratory Muscles; Vital Capacity

Topics: Aged; Arrhythmias, Cardiac; Atrial Fibrillation; Creatinine; Digitalis; Digoxin; Dyspnea; Edema; Female; Heart Failure; Humans; Male; Middle Aged; New York; Phytotherapy; Placebos; Plants, Medicinal; Plants, Toxic; Respiratory Insufficiency; Skilled Nursing Facilities; Time Factors

Digoxin-like immunoreactive factor (DLIF) is an endogenous substance with natriuretic and diuretic activity. Elevated plasma levels of DLIF are found in various clinical states characterized by water and sodium retention. Chronic respiratory failure, particularly of an advanced stage, also is frequently associated with water and sodium retention. In order to determine whether elevated plasma levels of DLIF are present in chronic respiratory failure, we measured plasma DLIF levels in seven patients (four with COPD [two of whom had associated sleep apnea disturbance] and three with kyphoscoliosis) suffering from advanced chronic respiratory failure with severe hypoxemia and hypercapnia. We found that in these patients plasma levels of DLIF were significantly higher than in healthy control subjects. We conclude that patients with advanced chronic respiratory failure respond with increased levels of DLIF. This may represent an attempt at homeostasis of water and sodium metabolism which is frequently deranged in this clinical condition.

Topics: Blood Proteins; Cardenolides; Chronic Disease; Digoxin; Female; Humans; Male; Middle Aged; Respiratory Insufficiency; Saponins; Sodium-Potassium-Exchanging ATPase

Combined therapy including digoxin improves the patients' clinical status and hemodynamics producing a normalizing effect on cardiac ejection, raises myocardial contractility, reduces pulmonary hypertension. The use of digoxin improves pulmonary metabolic function, lowers a degree of hypoxia. Combined evaluation of clinicofunctional data with regard for the dynamic determination of digoxin plasma concentration allows more effective glycoside therapy preventing the development of intoxication and resulting in a noticeable therapeutic effect. The use of digoxin is effective for initial and advanced stages of cardiopulmonary incompetence.

Topics: Adult; Bronchitis; Chronic Disease; Digoxin; Dose-Response Relationship, Drug; Drug Evaluation; Heart Failure; Hemodynamics; Humans; Middle Aged; Respiratory Insufficiency

We studied the effects of digoxin, a compound that has an inotropic effect on the myocardium, on diaphragmatic function in 8 patients with chronic obstructive pulmonary disease. All the patients were in acute respiratory failure and were artificially ventilated. Diaphragmatic strength was assessed by measuring the transdiaphragmatic pressure generated at functional residual capacity during bilateral supramaximal electrical stimulation of the phrenic nerves. The latter were stimulated before and at 45 and 90 min after administration of digoxin (0.02 mg/kg infused for 10 min). In all the patients, cardiac output was measured by the thermodilution technique using a Swan-Ganz catheter placed in the pulmonary artery. Arterial blood gases and pH were maintained within normal range by mechanical ventilation. In all the patients, digoxin plasma levels reached the therapeutic range (mean values, 2.82 +/- 0.17 and 2.90 +/- 0.20 nmol/L at 45 and 90 min, respectively) after digoxin administration. Diaphragmatic strength improves significantly after digoxin administration, the transdiaphragmatic pressure for an identical phrenic stimulation increasing by 19.5% (p less than 0.001) on the average. This increase was noted 45 and 90 min after digoxin administration. We conclude that digoxin has a potent effect on diaphragmatic strength generation that may be beneficial in patients with chronic obstructive pulmonary disease during acute respiratory failure. Furthermore, this inotropic positive effect of digoxin on the diaphragm, as previously observed for the myocardium, emphasizes the similarities between these 2 contractile tissues.

Topics: Action Potentials; Acute Disease; Aged; Diaphragm; Digoxin; Female; Hemodynamics; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Pressure; Respiratory Insufficiency

The effect of slow digitalization was tested by radioisotopic angiocardiography in 33 patients with stable and compensated chronic obstructive pulmonary disease (COPD); most of these had severe chronic respiratory failure (CRF). After a 10 days course of digoxin, 0.25 mg/die per os, both the left ventricular ejection fraction (LVEF) and the peak ejection rate (PER), initially slightly abnormal, improved significantly (t = -3.474, p less than 0.005; t = -2.438, p less than 0.025), while right ventricular ejection fraction (RVEF) and peak filling rate (PFR) did not. Ventricular diastolic interdependence and abnormal myocardial calcium kinetic are likely to account for PFR behaviour. Digoxin effects upon RVEF and LVEF suggest that the right ventricular systolic function is to some extent independent from the left one when blood gas derangement and abnormal thoracopulmonary mechanics are the major determinant of right ventricular afterload. The lack of significant correlation between digoxin effects on right and left ventricular function indices confirms this hypothesis. Digoxin can improve the left ventricular ejection phase indices, when these are initially abnormal, while its effect on RVEF is unpredictable.

Topics: Adult; Aged; Aged, 80 and over; Chronic Disease; Digoxin; Heart; Humans; Middle Aged; Respiratory Insufficiency; Stroke Volume

After seeing 9 cases of digitalis intoxication in patients with acute respiratory decompensation of chronic respiratory failure in one year in an intensive care unit, the authors decided to review the literature on the subject. They set out to: --determine the clinical, laboratory and electrical features of digitalis intoxication in patients with chronic respiratory failure, accounting for the frequency of supraventricular arrhythmias; --evaluate the frequency of this intoxication (20% in this study), introducing a definite risk factor, given the poor haemodynamic effectiveness of digitaloids in this indication; --establish a therapeutic management based on the use of anti-arrhythmics and especially on the prevention of predisposing factors (hypoxaemia--functional renal failure and abuse of diuretics).

Topics: Adult; Aged; Anti-Arrhythmia Agents; Chronic Disease; Critical Care; Digitalis Glycosides; Digoxin; Electrocardiography; Female; Humans; Male; Middle Aged; Respiratory Insufficiency; Retrospective Studies

Topics: Aged; Aminophylline; Atrial Flutter; Calcinosis; Cardiomegaly; Cefazolin; Digoxin; Heart Block; Humans; Male; Oxygen Inhalation Therapy; Pericarditis; Respiratory Insufficiency

Topics: Aged; Asthma; Bronchitis; Carbon Dioxide; Cardiac Catheterization; Conjunctiva; Diet, Sodium-Restricted; Digoxin; Edema; Eye Diseases; Female; Furosemide; Heart Failure; Humans; Hyperemia; Male; Middle Aged; Oxygen; Oxygen Inhalation Therapy; Potassium Chloride; Pulmonary Emphysema; Pulmonary Fibrosis; Pulmonary Heart Disease; Respiratory Insufficiency; Veins

Topics: Angiocardiography; Cardiac Catheterization; Cardiomegaly; Digoxin; Electrocardiography; Extracorporeal Circulation; Female; Furosemide; Heart Auscultation; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Heart Ventricles; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Male; Oxygen Inhalation Therapy; Pulmonary Valve Stenosis; Pulmonary Veins; Respiratory Insufficiency