Drotrecogin alfa (activated), now commonly known as Xigris, has been shown to significantly reverse organ dysfunction.1 Early intervention with Xigris reverses the pulmonary compromise of septic shock often within 48 hours. Due to this consistent effect in acute respiratory failure, we sought to evaluate the effect of drotrecogin alfa in burn patients with acute respiratory failure due to ARDS and/or direct lung injury (chemical, electrical, or toxic product).
Six patients were identified as having noninfectious(no positive cultures, not requiring antibiotics) acute respiratory distress syndrome by abnormal P/F ratios. Each was treated acutely with 24mcg/kg/min of Xigris continuously for 96 hours and their clinical and radiographic responses were evaluated.
Six males ages 28-39, three with thermal burns, one electrical injury, one chemical injury, and one severe inhalation injury without cutaneous burns were diagnosed with ARDS based on radiographic and initial P/F ratios. Mean P/F ratio Pre-Xigris was 80, with a mean P/F ratio Post-Xigris of 409. 50% of the patients did not require mechanical ventilation. Those ventilated were extubated much more rapidly than expected with ARDS, the maximun ventilation being eight days. All survived and had robust improvement in P/F ratios and radiographic presentation at 96 hours and sustained post-Xigris.
Drotrecogin alfa(activated) has a robust effect on acute ARDS in burn patients. This is consistent with data presented in non-burned, septic shock.
Xigris should be considered as a possible treatment for early inhalation injury and non-infectious ARDS. Larger open-labeled and/or prospective trials are warrented based on these significant clinical findings.
B.C. Friedman, None.