Prostaglandin E1 Group Research Articles

Improvement of arterial oxygenation by selective infusion of prostaglandin E1 to ventilated lung during one-lung ventilation.

One-lung anesthesia provides a better surgical field for thoracic procedures but also impairs the arterial oxygenation and venous admixture. During one-lung ventilation, pulmonary vasoconstriction is assumed to be present within both ventilated and collapsed lungs. We propose that arterial oxygenation could be optimized by offsetting the vasoconstriction within the microcirculation of ventilated lung. In an anesthetized dog model, incremental doses of prostaglandin E1 (PGE1) were selectively infused into the main trunk of the pulmonary artery of the ventilated lung after one-lung ventilation for 60 min (PGE1 group, n = 9). Arterial oxygenation and calculated venous admixture (Qs/Qt) was also assessed in a time-course control group (Control group, n = 5). During two-lung ventilation (FIO2: 0.66), arterial PO2 and venous admixture was 44.2 +/- 3.5 kPa and 10.7 +/- 2.3%, respectively. One-lung ventilation (FIO2: 0.66) with left lung collapsed reduced arterial PO2 to 11.6 +/- 1.7 kPa and increased venous admixture to 40.7 +/- 5.8% (P<0.001). Venous O2 tension also decreased from 6.3 +/- 0.7 kPa to 5.0 +/- 0.6 kPa with a slight increase in mean pulmonary artery pressure and pulmonary vascular resistance (P<0.05). During selective infusion of PGE1 at a dose of 0.04 to 0.2 mu g kg-1 min-1, there was a dose-dependent improvement in arterial PO2 with a parallel reduction of venous admixture during one-lung ventilation. Arterial PO2 increased to a maximum of 23.0 +/- 4.3 kPa, and the venous admixture decreased significantly to a minimum of 27.4 +/- 4.2% by PGE1 at a dose of 0.04-0.4 mu g kg-1 min-1 (P<0.01). PGE1 resulted in a small increase in cardiac output and decreases of pulmonary pressure and pulmonary vascular resistance at a relatively high dose of 0.4 mu g kg-1 min-1 during selective infusion (P<0.05). These results suggest that a selective pulmonary artery infusion of PGE1 to the ventilated lung within the dose range of 0.04-0.4 mu g kg-1 min-1 is practical and effective to improve arterial oxygenation and reduce venous admixture during one-lung ventilation.

Inhibitory effect of prostaglandin E1 on gastric secretion during general anesthesia in humans

The present study was undertaken to clarify the effects of prostaglandin E1 (PGE1) on gastric secretion during general anesthesia. Thirty-three patients, 16 with (PGE1 group) and 17 without (control group) PGE1 administration, scheduled for selective surgery were studied during general anesthesia with nitrous oxide (67%) and enflurane (1%-2% inspired). PGE1 was administered at a rate of 50-200 ng·kg(-1)·min(-1) when hypotensive medication was required. In the PGE1 group, gastric juice was collected serially three times before and during administration and 60 min after discontinuation of PGE1. In the control group, it was collected three times corresponding to those in the PGE1 group. The pH of gastric juice increased significantly, and the acidity and pepsin activity decreased after the beginning of the administration of PGE1, and these changes were observed even 1h after discontinuation. There was significant differences in the pH, acidity, and pepsin activity between the two groups after administration of PGE1. The results indicate that PGE1 inhibits gastric secretion at doses that produce a sufficient hypotensive effect under general anesthesia.

Prostaglanding E 1 or prostacyclin in euro-collins solution fails to improve lung preservation

In search of the ideal composition of the flush solution for pulmonary preservation, we studied the effects of prostaglandin E1 (PGE1) and prostacyclin as an additive to Euro-Collins solution (ECS) on pulmonary hemodynamics and gas exchange in a porcine single lung transplantation model using extracorporeal circulation and right heart bypass. Twenty-two pigs served as donors. The animals were randomized to receive either modified ECS alone (control group, n = 8), ECS with 100 micrograms/L of PGE1 (PGE1 group, n = 6), or ECS with 200 micrograms/L of prostacyclin (prostacyclin group, n = 8). Left lung transplantation was performed in 22 recipients after approximately 4 hours of cold ischemia. Carbon dioxide elimination was significantly depressed in the two prostaglandin groups, and the use of PGE1 was associated with a significant decrease in arterial oxygen tension compared with the control group. Both drugs were inefficient in alleviating the increase in pulmonary vascular resistance after transplantation. The use of prostaglandins as constituents of the flush solution was not followed by any improvement of early graft function after cold ischemia.

Effect of low-dose infusion of prostaglandin E1 on vecuronium-induced neuromuscular blockade.

The effect of low-dose (20 ng·kg-1·min-1) infusion of prostaglandin E1 (PGE1) on vecuronium-induced neuromuscular blockade was studied. The study population consisted of 24 elderly patients (65-75 years old) and 24 younger adult patients (25-56 years old). They were randomly assigned to the control and PGE1 groups. The steady-state dose requirement (SSDR) of vecuronium was derived from ondemand infusion of the drug which produced a stable twitch height of 20% of its baseline reading, and recovery time after steady-state infusion was defined as the time for recovery from twitch height from 25% to 75%. The patients in the PGE1 group received an infusion of PGE1 20 ng·kg-1·min-1, while those in the control group received an infusion of normal saline. The SSDR (23.2±9.1 and 34.2±5.9 μg·kg-1. hr-1, respectively;P=0.02) was significantly less and the recovery time (35.0±9.5 and 19.9±4.2 min, respectively;P=0.01) was significantly longer in the elderly than in the younger patients. However, low-dose infusion of PGE1 significantly increased the SSDR (23.2±9.1 to 37.4±3.7 μg· kg-1·hr-1;P=0.01) and shortened the recovery time (35.0±9.5 to 23.5±4.0 min;P=0.02) in elderly patients. We concluded that low-dose infusion of PGE1 is effective in preventing the prolonged action of vecuronium in elderly patients.

A randomized trial of management of pre-labor rupture of membranes at term in multiparous women using vaginal prostaglandin gel

To compare conservative management of pre-labor spontaneous rupture of membranes (SROM) with the use of prostaglandin (PG) E2 in healthy parous women at term (gestational age at least 37 weeks). An open randomized study was conducted with 100 parous women; 50 were treated conservatively for 24 hours, and 50 were managed actively using PGE2 gel (1 mg), administered at admission and repeated 6 hours later if labor was not established. Both groups received intravenous oxytocin if labor did not start within 24 hours after admission. The use of PGE2 gel led to a significant reduction in the mean interval (+/- standard error of the mean) from SROM to onset of labor: 17.26 +/- 1.51 hours in the conservative group versus 6.50 +/- 1.23 in the PGE2 group. A significantly smaller proportion of subjects required oxytocin in the PGE2 group (12 versus 38%, P < .02). The two groups were comparable with respect to analgesic requirements. Within 24 hours of SROM, 80% of the women in the PG group and 56% in the conservative group had delivered (P < .02). Most women delivered vaginally, 96% of those managed conservatively and 100% of those managed actively with PGE2. Active management using PGE2 gel in parous women with pre-labor SROM significantly improves the time to delivery without influencing the cesarean rate or fetal-maternal infective morbidity.

PANCREATIC CYTOPROTECTIVE EFFECTS OF PROSTAGLANDIN E1 IN PANCREATECTOMIZED PATIENTS

We studied the changes in serum levels of pancreatic enzymes during perioperative period of patients undergoing pancreatic surgery to examine the cytoprotective effect of prostaglandin E1 (PGE1) with improvement of pancreatic micro-circulation. Subjects were 16 patients who underwent pancreatectomy or gastrectomy with extended removal of lymph nodes surrounding the pancreas. They were randomly divided into a group treated with PGE1 comprising of 8 patients and control group comprising of another 8 patients. Primary diseases involved 9 advanced gastric cancers, 3 bile-duct or pancreatic cancers, and 4 pancreatic cystadenomas. PGE1 was continuously given at a dose of 0.01μg/kg/min from the start of surgery until 24 hours after the surgery. Gabexate mesilate was given to each group at a dose of 400mg/day for 5 days. The incidence of abnomally high levels of serum pancreatic amylase on the seventh day after the surgery was 88% in control and 13% in PGE1 group, with a significant difference (p<0.05). Postoperative levels of pancreatic amylase and trypsin were significantly lower in the PGE1 gruop than control group (p<0.05). These results suggest that perioperative administration of PGE1 may provide effective pancreatic cytoprotection and consequent prevention against acute pancreatitis following surgery which has a high motality rate.

Gemeprost for first trimester missed abortion

In 87 patients with a missed abortion prior to 13 weeks, the application of a prostaglandin (PG) E1 derivative (1 mg gemeprost, Cergem) was compared to conventional surgical termination of pregnancy by cervical dilatation and curettage. In 33 patients with PGE1 application, complete expulsion of the abnormal pregnancy occurred after an average of 2.8 +/- 1.5 vaginal suppositories. PGE1 treatment was effective in 76.7%, and surgical management was effective in 90.9% of patients. Sixty percent of the patients in the PGE1 group required analgesia because of uterine pain in comparison to 4.5% in the surgical group. The possibility of medical termination with synthetic PG derivatives should be further investigated.

Intensive vascular training in stage IIb of peripheral arterial occlusive disease. The additive effects of intravenous prostaglandin E1 or intravenous pentoxifylline during training.

In a randomized open study, the combination of either prostaglandin E1 (PGE1) or pentoxifylline with controlled vascular training was compared with vascular training alone in patients with peripheral arterial occlusive disease in stage IIb. Forty-four patients were randomly assigned to treatment either of intensive vascular training alone (n = 15) or in combination with either i.v. pentoxifylline (200 mg over 2 hours BID, n = 15) or PGE1 (40 micrograms over 2 hours BID, n = 14). The basic therapy was a well-defined routine for vascular training, which was identical for all groups. The duration of therapy was 4 weeks. In all three test groups, there was a significant increase in the walking distance. There was a 119% increase in symptom-free walking distance in the exercise-only group. In comparison with exercise alone, the additional administration of pentoxifylline produced no greater effect; the increase was 105%. In contrast, administration of PGE1 combined with exercise achieved a remarkable improvement of 604%. Between-group comparison revealed the significant superiority of treatment with PGE1 (P < .05). During the 1-year follow-up, there was a reduction in the walking performance in all groups, albeit of variable extent. In the exercise-only and the pentoxifylline groups, the maintained increase in walking distance was only 30% compared with baseline values before the beginning of therapy. In the PGE1 group, on the other hand, the maintained improvement was 149%. Nine of 14 patients were still in stage IIa of peripheral arterial occlusive disease 1 year after PGE1 therapy.

Effects of newly developed solutions containing trehalose on twenty-hour canine lung preservation

Trehalose is a nonreducing disaccharide that stabilizes the cell membrane under various stressful conditions. A previous study demonstrated that trehalose was effective in 12-hour canine lung preservation. We have developed new preservation solutions containing trehalose: an extracellular type ET-Kyoto solution (Na 100 mmol/L, K 44 mmol/L) and an intracellular type IT-Kyoto solution (Na 20 mmol/L, K 130 mmol/L). The composition of these solutions is identical except for the electrolyte content. We examined their efficacy in 20-hour lung preservation. Canine lungs were flushed with ET-Kyoto (group A, n = 6), with IT-Kyoto and prostaglandin E1(25 μg/kg) (group B, n = 6), or with Euro-Collins solution and prostaglandin E1(25 μg/kg) (group C, n = 7), and stored for 20 hours at 4° C. Left lung transplantation was performed and evaluated for up to 130 minutes. The flush time was similar in the three groups. Arterial oxygen tensions (inspired oxygen fraction = 0.5) in group A were uniformly excellent (303.3 ± 7.0 mm Hg 70 minutes after reperfusion and 303.0 ± 19.6 mm Hg 130 minutes after reperfusion) and significantly higher than in group B (202.6 ± 32.0 mm Hg, p < 0.05, and 197.8 ± 44.0 mm Hg, p = 0.054, respectively) or group C (185.9 ± 23.0 mm Hg, p < 0.01, and 155.7 ± 36.3 mm Hg, p < 0.05, respectively). Peak inspiratory pressure in group A was significantly lower than in groups B and C (p < 0.05). Wet/dry weight ratio in group A was significantly lower than in groups B ( p < 0.05) and C ( p < 0.01). Histologic and scanning electron microscopic examinations showed better preservation in group A than in groups B and C. We conclude that ET-Kyoto is superior to IT-Kyoto and to Euro-Collins solution for 20-hour lung preservation. (J T HORAC CARDIOVASC SURG 1994;108:92-8)

Effect of prostaglandin E1 on arterial ketone body ratio in hepatectomy.

We evaluated the effect of prostaglandin E1 (PGE1) administration during hepatectomy on arterial ketone body ratio (AKBR), which is an indicator of liver function, and on other liver functions in the postoperative period. Eighteen patients were divided into two groups: Continuous intravenous administration of PGE1 (0.02 μg·kg-1·h-1) was started immediately before hepatic resection and ceased at the end of operation in nine patients (PGE1 group); the other nine did not receive PGE1 (control group). After hepatic resection, a significant increase in AKBR was observed in the PGE1 group. However, no change was observed in the control group. In the PGE1 group, total bilirubin and SGOT recovered more rapidly to the preoperative level than in the control group. These findings suggested that PGE1 might have a protective effect on the liver.

Experimental study of subcutaneous heterotopic intestinal graft ? effect of prostaglandin E1 on the viability

In this study, prostaglandin E1 (PGE1) was administered daily in a subcutaneous heterotopic jejunal model in rats to compare the results of the viability rate to those in the non-PGE, group. The viability rate of the PGE1 group was 28.6% in the day 5 ligated group, 75.0% in the day 7 ligated group and 100% in the day 14 ligated group. The viability rate of the non-PGE1 group was 0%, 37.5%, and 100%. The results of the PGE1 group in the day 5 and day 7 ligated groups were significantly different from those in the non-PGE1 group. These results indicate that the administration of PGE1 facilitates the neovascularization necessary for survival of the grafted tissue and shortens the time for the graft to become viable at the implantation site.

Hepatic Blood Flow and Energy Metabolism During Hypotension Induced by Prostaglandin E1 and Nicardipine in Rabbits

Hepatic blood flow (HBF) and energy metabolism during moderate hypotension induced by prostaglandin E1 (PGE1) and nicardipine were studied by in vivo magnetic resonance spectroscopy. HBF was determined by the deuterated water clearance method by using deuterium magnetic resonance spectroscopy, and energy metabolism was estimated from the changes in the levels of adenosine triphosphate and inorganic phosphate by using phosphorus (31P) magnetic resonance spectroscopy. Mean arterial blood pressure was intentionally reduced to 60% of control with PGE1 (n = 5) or nicardipine (n = 5). The HBF decreased by 38% and by 50% during the hypotension induced by PGE1 and nicardipine, respectively. The level of adenosine triphosphate decreased by 12% and that of inorganic phosphate increased by 80% during nicardipine-induced hypotension, whereas the corresponding levels showed no remarkable changes during PGE1-induced hypotension. After the cessation of drug administration, mean arterial blood pressure and HBF recovered to the control levels in the PGE1 group, but not completely in the nicardipine group. In the latter group, the level of inorganic phosphate did not recover either. These results indicate that during hypotension induced with PGE1 hepatic circulation and metabolism are conserved to a greater extent than during hypotension induced with nicardipine.

Effect of prostaglandin E1 on preservation injury of canine liver grafts preserved in UW solution.

This study investigated whether prostaglandin E1 (PGE1) could reduce hepatic injury to the liver graft caused by harvesting and 24-h preservation in University of Wisconsin (UW) solution in a canine model. The PGE1-treated group was intravenously administered 0.5 microgram/kg per minute of PGE1 for 30 min before harvesting, as well as a concentration of 1 mg/l PGE1 in the washout and UW solutions. In both the PGE1-treated and the control group, all recipients survived for 1 week or more after transplantation. Arterial ketone body ratio (AKBR) remained over 1.0 in the early postoperative period. The PGE1 group showed significant reductions in guanase, GOT, and LDH during the early postoperative period compared to the untreated control group. Histological examination disclosed partial mitochondrial swelling, hepatocyte vacuolation, and necrosis in the control group, while such abnormalities were rarely seen in the PGE1 group. These results suggest that PGE1 can effectively reduce hepatic injury to liver grafts preserved in UW solution prior to transplantation.

Somatosensory evoked potential, a prognostic tool for the recovery of motor function following malperfusion of the spinal cord: Studies in dogs

The potential usefulness of somatosensory evoked potential monitoring during aortic cross-clamping is slowly being realized. In addition, the protection of endangered spinal nervous tissue during aortic cross-clamping has not been sufficiently evaluated. To test the pharmacologic protective efficacy of various agents, we recorded spinal evoked somatosensory potentials (bipolar epidural catheter) in dogs under controlled conditions (N2O/O2-enflurane anesthesia) following clamping of the aorta for 1 hour. There were 5 groups of animals: those treated with different medications, such as prostaglandin E1 (PGE1), prostacyclin (PGI2), superoxide dismutase (SOD), and PGE1 plus SOD for pharmacologic protection during ischemia, and the controls. The time to recovery of evoked potentials during the reperfusion period was 36 minutes in the controls, 15.9 minutes in the SOD group (p < 0.01), 12.5 minutes in the PGE1 group (p < 0.001), 10.8 minutes in the PGI2 group (p < 0.001), and 3.8 minutes in the combination group (p < 0.001). In addition, treatment resulted in a better neurologic outcome on the seventh postoperative day when compared with the control group. While in the control group only 1 animal could walk (9%), 7 of 12 in the PGE1 group (58%), 4 of 12 in the SOD group (33.8%), 8 of 12 in the PGI2 group (66.7%), and all animals in the combination group (100%) could walk. We computed an exponential correlation that related the mean time of potential recovery during reperfusion with Tarlov scoring (grade 0 = paraplegia; grade 1 = paraplegia with little movements; grade 2 = paraparesis; grade 3 = paraparesis with some problems; grade 4 = normal motor function) in the various groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of induction of labor with prostaglandin E2 on fetal breathing and body movements: Controlled, randomized, double‐blind study

To evaluate the effects of prostaglandin (PG) E2, given for induction of labor at term, on fetal breathing and body movements.Eighteen women with term pregnancies, mild gestational hypertension, intact membranes, and unripe cervices who were not in labor participated in this study. After a 60-minute baseline ultrasound examination of fetal chest and body movements, recorded on videotape, the patients were randomly assigned to either 3 mg intravaginal PGE2 tablets or controls (placebo intravaginal tablets). Following tablet insertion and a 3-hour observation time, a second 60-minute ultrasound recording of fetal movements was taped. The videotape recordings were interpreted according to the total amount of time occupied by fetal body movements and fetal breathing movements.There was a total of 2180 minutes of ultrasound tape recordings, with 136.2 minutes of fetal body movements (6.2%) and 207.8 minutes of fetal breathing movements (9.5%). Mean (+/- standard deviation) observation times per patient before and after tablet insertion were 60.3 +/- 1.2 and 56.4 +/- 1.2 minutes for the PGE2 group and 60.1 +/- 1.3 and 60.4 +/- 1.1 minutes for the control group. Three hours after PGE2 insertion, there were significant decreases in the percentage of time occupied by body movements (7.8 +/- 3.1 versus 3.4 +/- 2.0%; P < .003) and breathing movements (10.6 +/- 8.6 versus 3.9 +/- 2.3%; P < .007). Three hours after tablet insertion, there were statistically significant decreases in the percentage of time occupied by body movements (P < .025) and breathing movements (P < .01) between the control and study groups.Induction of labor with intravaginal PGE2 tablets inhibits fetal body and breathing movements. The effects could be due to direct action on the fetus or indirect effects of PGE2 (through uterine contraction and/or endogenous PG).

Liver transplantation in positive cytotoxic crossmatch cases using FK506, high-dose steroids, and prostaglandin E1.

Liver transplantation in positive cytotoxic crossmatch cases using FK506, high-dose steroids, and prostaglandin E1.

Efficacy of prostaglandin E2 and ursodeoxycholic acid after portoenterostomy in the prognostically unfavorable type III biliary atresia

Nineteen patients with type III congenital biliary atresia (CBA) were treated by portoenterostomy. In the histological sections, bile ductule diameters below 100 μm and age-dependent liver fibrosis of grade II–IV were found. In group A, 8 patients received no postoperative choleretic therapy; in group B, 6 patients were treated with prostaglandin E2 (PG E2); and in group C, in 5 patients ursodeoxycholic acid (UDCA) was added to the PG E2 therapy. In the first 3 postoperative months a significant beneficial effect of PG E2 was observed as reduced serum bilirubin and aspartate aminotransferase (AST) levels relative to the untreated group. In group C (UDCA and PG E2) significantly lower serum levels of all liver parameters relative to the untreated group and gradually decreased levels of bilirubin, alanine aminotransferase (ALT), g-glutamyl transferase (GGT), and higher cholinesterase (CHE) activity were observed than in the PG E2 group. During episodes of cholangitis steroids were also added, but alterations in serum bilirubin levels, CHE activity, and bile flow did not improve after any adjunctive therapy. Liver enzyme activity was immediately elevated in groups A and B, but significantly lower in group C. The efficacy of both drugs, PG E2 and UDCA, lasted only for the first 3 post-operative months and failed to improve or delay the progression of hepatic damage. After portoenterostomy, 13 patients (68%), died within 6–32 months, 12 from progressive liver failure and 1 after liver transplantation. Six patients (32%) are alive, 3 after liver transplantation; 2 are jaundice-free and 1 jaundiced patient is on a waiting list for transplantation. In these prognostically poor patients with type III CBA, early liver transplantation is the only feasible option as adjuvant Pg E2, UDCA, and corticosteroid therapy demonstrated no long-term improvement after portoenterostomy.

Effects of Alprostadil (synthetic prostaglandin E1) on red and white cell filterability during cardiopulmonary bypass

Reduced blood cell rheology due to mechanical blood trauma is associated with reduced microcirculation and organ dysfunction during and following cardiac surgery using cardiopulmonary bypass (CPB). The influence of prostaglandin E1 (PGE1) on the blood cell rheology was studied in 24 patients undergoing coronary artery bypass grafting surgery with the use of CPB. Intra-operative infusion of PGE1 was given to 12 patients in a dose of 20ng/kg/min; the other 12 patients served as controls. Red and white cell rheology were measured by red and white cell filtration rate (RFR and WFR) respectively, applying a standard bulk filtration technique. Blood samples were collected pre-operatively, at the start of CPB, after 30 minutes, 60 minutes, 90 minutes and at the end of CPB. Results showed that the mechanical trauma of CPB was better tolerated in the PGE1 group, where RFR and WFR showed significant lower losses during CPB (p &lt; 0.001, p &lt; 0.001). These results indicate that PGE1 has beneficial effects on red and white cell deformability during CPB. The improvement of blood rheology would be expected to lead to better microcirculation in the vital organs.

Effect of prostaglandin E1on graft function of kidneys from living related donors

Prostaglandin E1 (PGE1) was used in renal transplant recipients with living related donors. The drug was given intravenously from day 1 to day 7 after transplantation at a dose of 40 µg/kg twice a day. A total of 45 patients were studied divided into two groups: 25 patients were treated with PGE1 (group B) and the remaining 20 patients did not receive the drug (group A). In group B, 24-h creatinine clearance (Ccr) was 66 ± 12.8 ml/min compared with 40.3 ± 13.4 ml/min in group A on the fifth postoperative day (P < 0.05). Urinary levels of N-acetyl-β-d-glucosaminidase (NAG) and serum levels of platelet factor 4 (PF4) in group B were significantly lower than in group A. On the fourth postoperative day, the urinary excretion of thromboxan B2 (TxB2) in group A was higher than in group B, but not significantly (5.1 ± 3.0 ng/day and 2.8 ± 1.1 ng/day, respectively). Acute rejection occurred in four patients in group B and in 10 patients (40%) in group A. The percentage of Leu2a-positive lymphocytes in group B was higher than in group A. We conclude that postoperative administration of PGE1 improves graft function in kidneys from living related donors.

THE EFFECTS OF PROSTAGLANDIN E1 (PGE1) ON NON-PULMONARY ORGAN FUNCTION DURING CLINICAL ACUTE RESPIRATORY FAILURE (ARDS)

The effects of prostaglandin E1 (PGE1) on non-pulmonary vital organs in critically ill patients are not well defined. This study evaluated the role of exogenous PGE1 in systemic homeostasis during the adult respiratory distress syndrome (ARDS). Indicators of end-organ function were analyzed retrospectively in 146 septic or post-trauma patients with ARDS who received PGE1 (30/ng/kg/min) or placebo IV for up to 7 days in a randomized, double-blind clinical trial. Hemodynamic variables and serum levels of creatinine, bilirubin, and SGOT, platelet count, and changes in the white blood cell count were measured daily. Our results indicate that mean arterial pressure, pulmonary artery pressure, and systemic and pulmonary vascular resistance indices were significantly lower in the PGE1 group versus the placebo-treated group. Cardiac index, stroke index, and oxygen delivery index were significantly increased in the PGE1 group. Serum bilirubin and SGOT were decreased significantly among PGE1-treated patients compared with placebo-treated patients, while the white blood cell count increased more significantly from baseline values with PGE1 treatment. Intergroup differences in platelet count and serum creatinine levels were not statistically significant. The results indicate that PGE1 improves cardiovascular performance, hepatic function, and leukocyte availability during clinical ARDS. Prostaglandin E1 did not affect platelet counts and renal function in this study.