• L Donaldson, I S Grant, M R Naysmith, and J S Thomas.
• Department of Anaesthetics, Ninewells Hospital, Dundee, UK.
• Intensive Care Med. 1998 Jun 1; 24 (6): 626630626-30.

ObjectiveTo 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).DesignRetrospective study. Review of clinical and pathological findings of patients dying from ARDS.SettingIntensive Care Unit (ICU) and Pathology Department of University hospital.SubjectsTen patients with clinical diagnosis of ARDS, who died in ICU and underwent post mortem examination.InterventionsCase note review of clinical details; independent review of histological specimens.Measurement And ResultsOver 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.ConclusionsAcute 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.

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