Acute amiodarone-induced lung toxicity

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Abstract
Objective: To investigate any relationship between the pathological features of amiodarone-induced pulmonary toxicity (APT) and clinical use of amiodarone in patients dying from acute respiratory distress syndrome (ARDS). Design: Retrospective study. Review of clinical and pathological findings of patients dying from ARDS. Setting: Intensive Care Unit (ICU) and Pathology Department of University hospital. Subjects: Ten patients with clinical diagnosis of ARDS, who died in ICU and underwent post mortem examination. Interventions: Case note review of clinical details; independent review of histological specimens. Measurement and results: Over a 3-year period, ten patients underwent post mortem examination, of whom seven had received amiodarone. Three patients who received longer than 48 h of amiodarone had histological changes of widespread lipoid pneumonia, a recognised pattern of APT. Conclusions: Acute amiodarone pulmonary toxicity is a definite pathological entity in ICU patients. High oxygen concentrations may be a risk factor, while pre-existing pathology, e. g. ARDS, may mask its development. Amiodarone should be used with caution in this group of patients.