Dose-Response to Inhaled Aerosolized Prostacyclin for Hypoxemia Due to ARDS

Heerden, Peter Vernon van; Barden, Anne; Michalopoulos, N.; Bulsara, Max; Roberts, Brigit

doi:10.1378/chest.117.3.819

Cited by 112 publications

(83 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…86 Several RCTs have consistently shown modest to moderate short-term improvement in oxygenation in patients with ARDS treated with INO. [87][88][89][90] The level of evidence supporting aerosolized PGI 2 therapy in ARDS is much weaker, usually consisting of small uncontrolled studies 85,91 and case reports [92][93][94] describing modest to moderate improvements in oxygenation. However, this has not been found consistently among all investigations.…”

Section: Aerosolized Prostaglandins and Inhaled Nitric Oxidementioning

confidence: 99%

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

Kallet

2013

Respir Care

View full text Add to dashboard Cite

Mechanically ventilated patients in respiratory failure often require adjunct therapies to address special needs such as inhaled drug delivery to alleviate airway obstruction, treat pulmonary infection, or stabilize gas exchange, or therapies that enhance pulmonary hygiene. These therapies generally are supportive in nature rather than curative. Currently, most lack high-level evidence supporting their routine use. This overview describes the rationale and examines the evidence supporting adjunctive therapies during mechanical ventilation. Both mechanistic and clinical research suggests that intrapulmonary percussive ventilation may enhance pulmonary secretion mobilization and might reverse atelectasis. However, its impact on outcomes such ICU stay is uncertain. The most crucial issue is whether aerosolized antibiotics should be used to treat ventilatorassociated pneumonia, particularly when caused by multi-drug resistant pathogens. There is encouraging evidence from several studies supporting its use, at least in individual cases of pneumonia non-responsive to systemic antibiotic therapy. Inhaled pulmonary vasodilators provide at least short-term improvement in oxygenation and may be useful in stabilizing pulmonary gas exchange in complex management situations. Small uncontrolled studies suggest aerosolized heparin with N-acetylcysteine might break down pulmonary casts and relieve airway obstruction in patients with severe inhalation injury. Similar low-level evidence suggests that heliox is effective in reducing airway pressure and improving ventilation in various forms of lower airway obstruction. These therapies generally are supportive and may facilitate patient management. However, because they have not been shown to improve patient outcomes, it behooves clinicians to use these therapies parsimoniously and to monitor their effectiveness carefully. Key words: high-frequency percussive ventilation; intrapulmonary percussive ventilation; inhaled nitric oxide; aerosolized prostacyclin; aerosolized heparin; metered-dose inhalers; heliox.

show abstract

Section: Aerosolized Prostaglandins and Inhaled Nitric Oxidementioning

confidence: 99%

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

Kallet

2013

Respir Care

View full text Add to dashboard Cite

show abstract

“…19). Van Heerden et al berichten ab einer Dosis von 50 ng/kg/min über einen relevanten Anstieg der Konzentration von 6-keto-PGF 1α im Plasma [62]. Plasmaspiegel von Iloprost bzw.…”

Section: Systemische Vasodilatationunclassified

“…In neueren Untersuchungen fand sich dagegen kein konsistenter Effekt von inhaliertem PGI 2 auf die Thrombozytenfunktion. So war die Adenosin induzierte Plättchenaggrega-tion bei 9 Patienten mit ARDS selbst in hoher Dosierung von 50 ng/kg/min unverändert [62]. Klinisch wurde eine verstärkte Blutungsneigung auch unter län-ger dauernder Therapie mit inhalierten Prostanoiden bislang nicht beobachtet.…”

Section: Hemmung Der Thrombozytenaggregationunclassified

See 1 more Smart Citation

Inhalierte Vasodilatatoren

Zwißler¹

2002

Anaesthesist

View full text Add to dashboard Cite

First reports on the use of inhaled nitric oxide (NO) in patients were published in 1991. These reports confirmed data from animal experiments which suggested a selective vasodilatory effect of inhaled NO in pulmonary vessels. As the main clinical effects, both improved oxygenation and a drop of pulmonary artery pressure despite unchanged arterial pressure were observed. Since then, many studies have evaluated the effects of inhaled NO as well as of other aerosolised vasodilators (e.g. PGI(2), PGE(1), nitrates, phosphodiesterase-inhibitors) in patients with pulmonary hypertension, acute right heart failure and/or life-threatening hypoxemia. However, primary pulmonary hypertension of the newborn (PPHN) is the only indication for which inhaled NO has been clinically approved so far. Although an obvious clinical benefit in outcome from inhaled vasodilators has never been formally documented, good clinical efficacy has resulted in an increasing "off label" use of the concept both in Germany and worldwide, particularly with respect to anaesthesia and intensive care medicine. The present article aims to review both the pathophysiological and pharmacological basis of inhaled vasodilators, to critically reevaluate their potential clinical indications and to give a perspective on future developments in the field.

show abstract

“…min −1 den pulmonalen Gefäßto-nus selektiv senken und die Oxygenierung verbessern kann[41]. Eine Reihe von Studien hat die Verbesserung des PaO 2 sowie eine Senkung des pulmonalarteriellen Druckes bei ARDS-Patienten bestätigen können[40,42,44]. Die Selektivität von inhaliertem PgI 2 hängt jedoch von der applizierten Dosis ab.…”

unclassified

Stellenwert von inhaliertem Stickstoffmonoxid bei der Behandlung des schweren akuten Lungenversagens

et al. 2004

View full text Add to dashboard Cite

Acute respiratory distress syndrome (ARDS) is characterized by perfusion in favor of non-ventilated areas of the lungs as the main cause of intrapulmonary right-to-left shunt and hypoxemia. Therapeutic interventions to selectively influence pulmonary perfusion in ARDS became possible with the introduction of inhaled nitric oxide (iNO), which provided a way not only to reduce pulmonary hypertension, but also to acutely improve ventilation-perfusion mismatch, and thus to treat severe hypoxemia. Clinical studies in ARDS demonstrated that the combination of iNO with other interventions, such as positive end-expiratory pressure (PEEP) and prone positioning, yielded beneficial and additive effects on arterial oxygenation. Although randomized controlled trials of this concept have up to now failed to show an improved outcome, iNO is a valuable option for the treatment of severe refractory hypoxemia in ARDS patients.

show abstract

Dose-Response to Inhaled Aerosolized Prostacyclin for Hypoxemia Due to ARDS

Cited by 112 publications

References 30 publications

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

Adjunct Therapies During Mechanical Ventilation: Airway Clearance Techniques, Therapeutic Aerosols, and GasesDiscussion

Inhalierte Vasodilatatoren

Stellenwert von inhaliertem Stickstoffmonoxid bei der Behandlung des schweren akuten Lungenversagens

Contact Info

Product

Resources

About