mesna and Respiratory-Insufficiency

To determine whether bolus instillation of a mucolytic agent (mesna) could diminish airway resistance, endotracheal tube resistance, or both in patients mechanically ventilated for acute respiratory failure.. Randomized, double-blind, placebo-controlled, crossover trial.. Medical-surgical ICU of a county hospital covering 350,000 inhabitants.. Twenty sedated and paralyzed patients with an endotracheal tube (ET) in place more than 72 h.. Data were recorded in three steps: (1) basal; (2) 10 min after endotracheal instillation of 3 mL of either saline solution or mesna; and (3) 10 min after instillation of the opposite drug. A 2-h washout period was allowed between data collection.. We measured tidal volume (VT), inspiratory flow (VI), auto-PEEP, peak pressure (both at airway opening [Pmax.aw] and trachea [Pmax-.tr]) and plateau pressure (Pplat), and we calculated respiratory system compliance (Crs) and the inspiratory resistances of airways+tube (Rmax.aw), airways (Rmax.tr), and ET (Rtube). We found significant differences after the instillation of mesna compared with baseline in the following: airway plus tube resistance (Rmax.aw) (16.9 +/- 7.1 vs 18.9 +/- 7.7 cm H2O); airways resistance (Rmax.tr) (9.8 +/- 6.2 vs 12.0 +/- 6.4 cm H2O), PaO2 (96 +/- 28.5 vs 80 +/- 24.8 mm Hg), PaO2/PAO2 (0.360 +/- 0.152 vs 0.296 +/- 0.127), and PaCO2 (42 +/- 12.9 vs 43 +/- 14.1 mm Hg). We found no changes in compliance, auto-PEEP, and hemodynamics during the study. Instillation of saline solution had no effect on the physiologic variables studied.. In our patients, bolus tracheal instillation of mesna does not improve airway resistance; in fact, mesna instillation induces episodes of bronchospasm that disappear 2 h later.

Topics: Aged; Aged, 80 and over; Airway Resistance; Bronchial Diseases; Constriction, Pathologic; Cross-Over Studies; Double-Blind Method; Female; Hemodynamics; Humans; Intubation, Intratracheal; Male; Mesna; Middle Aged; Pulmonary Gas Exchange; Respiration, Artificial; Respiratory Insufficiency

A 37-year-old male developed massive pleural effusion leading to respiratory failure and electromechanical dissociation within 24 h after the second dose of 4200 mg cyclophosphamide (CY) during conditioning for allogeneic bone marrow transplantation for chronic myelogenous leukemia. After resuscitation and bilateral pleural drainage he recovered within 1 day. Subsequently, total body irradiation was given and with a delay of 1 day the transplantation procedure was continued without major complications. No explanation for this idiosyncratic reaction other than the administration of high dose CY in combination with mesna rescue was found. This reaction has not been reported before in the literature.

Topics: Adult; Bone Marrow Transplantation; Cyclophosphamide; Drainage; Fluid Therapy; Heart Arrest; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Mesna; Pleural Effusion; Respiratory Insufficiency; Transplantation Conditioning; Whole-Body Irradiation

Topics: Abdomen; Adult; Aged; Blood Gas Analysis; Blood Pressure; Cardiac Output; Chronic Disease; Expectorants; Female; Humans; Male; Mercaptoethanol; Mesna; Middle Aged; Oxygen; Postoperative Care; Pulmonary Diffusing Capacity; Respiratory Insufficiency; Risk