Evaluation of Continuous Inhaled Epoprostenol in the Treatment of Acute Respiratory Distress Syndrome, Including Patients With SARS-CoV-2 Infection

Niss, Hannah; Mohamed, Adham; Berry, Timothy P.; Saettele, Timothy; Haines, Michelle; Thomas, E. Louise

doi:10.1177/10600280211069182

Cited by 3 publications

(6 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is unclear the exact reason for those with CARDS having an increased length of hospitalization but is most likely related to a multifactorial process involving the progression of the disease and the timing of a patient's illness. These data are consistent with recently published data that showed that those with CARDS had a 6.5-day longer stay than those with traditional ARDS [16]. Prior to making a formal recommendation on the usage of iEPO in CARDS, however, further randomized controlled trials are needed to assess the effects on patient-centered outcomes, including elucidating the reasons why patients with CARDS had a longer LOS as compared to those with ARDS.…”

Section: Discussionsupporting

confidence: 86%

A Comparison of Inhaled Epoprostenol in Patients With Acute Respiratory Distress Syndrome and COVID-19-Associated Acute Respiratory Distress Syndrome

Santarelli¹,

Wilks²,

Latu³

et al. 2022

Cureus

View full text Add to dashboard Cite

IntroductionAcute respiratory distress syndrome (ARDS) and coronavirus disease 2019 (COVID-19)-associated acute respiratory distress syndrome (CARDS) are both characterized by non-cardiogenic pulmonary edema and severe hypoxemia that leads to a high percentage of patients suffering in-hospital mortality. Mechanistically, inhaled epoprostenol (iEPO) has shown a role in the treatment of ARDS and CARDS but little data are available directly comparing the two disease processes. Due to the lack of evidence of iEPO in ARDS and CARDS, the authors sought to compare the pulmonary effects of iEPO for mechanically ventilated patients with CARDS against a case match control of those with ARDS. MethodsA retrospective cohort of all patients receiving iEPO between January 1, 2020, and February 22, 2022, was reviewed. Patients with ARDS were case-matched in a 2:1 allocation ratio of CARDS to ARDS by the number of medical comorbidities and age +/-5 years. Clinical data collected included patient demographics, laboratory values, ventilator settings, length of hospitalization, and 28-day mortality. Comparisons of the effectiveness of iEPO between ARDS and CARDS were conducted using the chi-squared statistic for categorical variables and the Mann-Whitney statistic for continuous variables. ResultsA total of 72 patients were included in the final analysis, with 24 having ARDS and 48 CARDS. The number of medical comorbidities was no different for patients with ARDS or CARDs (p = 0.18), though the frequency of patients diagnosed with coronary artery disease (p=0.007), congestive heart failure (p=0.003), chronic obstructive pulmonary disease (p=0.004), and pulmonary hypertension (p=0.004) did vary between the two groups. A moderate but non-significant difference in pre-iEPO partial pressure of oxygen (PaO 2 )/fraction of inspired oxygen (FiO 2 ) ratio was noted between the groups (0.74 vs 0.65; p=0.33). Following iEPO treatment, patients with ARDS showed a greater PaO 2 /FiO 2 ratio than those with CARDS (0.87 vs 0.70; p=0.02). CARDS patients who received iEPO had a longer length of stay as compared to those with ARDS (17.5 vs 12.5 days; p=0.01). However, no difference was noted in 28-day mortality between the two groups (14 vs 34; p=0.29). ConclusionIn this small sample from a single community hospital, a statistically significant improvement in the PaO 2 /FiO 2 ratio was noted for both those with ARDS and CARDS. However, those with CARDS who were given iEPO had a longer length of stay without a significant difference in mortality as compared to those with traditional ARDS.

show abstract

Section: Discussionsupporting

confidence: 86%

A Comparison of Inhaled Epoprostenol in Patients With Acute Respiratory Distress Syndrome and COVID-19-Associated Acute Respiratory Distress Syndrome

Santarelli¹,

Wilks²,

Latu³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…62 This study also determined lower baseline P/F ratios and non-COVID-19 ARDS were significant predictors of positive response to iEPO. 62…”

Section: Inhaled Prostaglandinsmentioning

confidence: 68%

“…61 A multicenter retrospective study by Niss et al included patients with both COVID-19-associated ARDS and non-COVID-19 ARDS and saw a majority of patients having a positive response to iEPO, defined as greater than 10% increase in P/F ratio within 6 hours of administration. 62 This study also determined lower baseline P/F ratios and non-COVID-19 ARDS were significant predictors of positive response to iEPO. 62 Imtiaz et al performed a retrospective case series of patients with COVID-19-associated ARDS who received iEPO at an initial dose of 50 ng/kg/min.…”

Section: Clinical Efficacy In Covid-19-associated Ardsmentioning

confidence: 68%

A Narrative Review on the Administration of Inhaled Prostaglandins in Critically Ill Adult Patients With Acute Respiratory Distress Syndrome

Ware,

Kim,

Szumita

et al. 2023

Ann Pharmacother

View full text Add to dashboard Cite

Objective: To describe the effect of inhaled prostaglandins on both oxygenation and mortality in critically ill patients with acute respiratory distress syndrome (ARDS), with a focus on safety and efficacy in coronavirus disease 2019 (COVID-19)-associated ARDS and non-COVID-19 ARDS. Data Sources: A literature search of MEDLINE was performed using the following search terms: inhaled prostaglandins, inhaled epoprostenol, inhaled nitric oxide, ARDS, critically ill. All abstracts were reviewed. Study Selection and Data Extraction: Relevant English-language reports and studies conducted in humans between 1980 and June 2023 were considered. Data Synthesis: Data regarding inhaled prostaglandins and their effect on oxygenation are limited but show a benefit in patients who respond to therapy, and data pertaining to their effect on mortality is scarce. Concerns exist regarding the formulation of inhaled epoprostenol (iEPO) utilized in addition to modes of medication delivery; however, the limited data surrounding their use have shown a reasonable safety profile. Other avenues and beneficial effects may exist with inhaled prostaglandins, such as use in COVID-19-associated ARDS or non-COVID-19 ARDS patients undergoing noninvasive mechanical ventilation or during patient transport. Relevance to Patient Care and Clinical Practice: The use of inhaled prostaglandins can be considered in critically ill patients with COVID-19-associated ARDS or non-COVID-19 ARDS who are experiencing difficulties with oxygenation refractory to nonpharmacologic strategies. Conclusions: The use of iEPO and other inhaled prostaglandins requires further investigation to fully elucidate their effects on clinical outcomes, but it appears these medications may have a potential benefit in COVID-19-associated ARDS and non-COVID-19 ARDS patients with refractory hypoxemia but with little effect on mortality.

show abstract

“…Eventually, 18 studies were included in the 1-arm meta-analysis (13 single arm retrospective studies 18 – 30 and 5 case series 31 – 35 ) and three studies 13 , 14 , 36 in the 2-arm meta-analysis. Figure 1 shows the PRISMA flow chart that illustrates how the final studies were selected.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 782 studies underwent full-length review. Subsequently, we excluded 761 studies because of the following: 317 studies used interventions not involved in our study Eventually, 18 studies were included in the 1-arm metaanalysis (13 single arm retrospective studies [18][19][20][21][22][23][24][25][26][27][28][29][30] and 5 case series [31][32][33][34][35] ) and three studies 13,14,36 in the 2-arm meta-analysis. Figure 1 shows the PRISMA flow chart that illustrates how the final studies were selected.…”

Section: Study Selectionmentioning

confidence: 99%

Inhaled Pulmonary Vasodilators in COVID-19 Infection: A Systematic Review and Meta-Analysis

Khokher

Malhas

Beran

et al. 2022

J Intensive Care Med

View full text Add to dashboard Cite

Introduction: Inhaled pulmonary vasodilators (IPVD) have been previously studied in patients with non-coronavirus disease-19 (COVID-19) related acute respiratory distress syndrome (ARDS). The use of IPVD has been shown to improve the partial pressure of oxygen in arterial blood (PaO2), reduce fraction of inspired oxygen (FiO2) requirements, and ultimately increase PaO2/FiO2 (P/F) ratios in ARDS patients. However, the role of IPVD in COVID-19 ARDS is still unclear. Therefore, we performed this meta-analysis to evaluate the role of IPVD in COVID-19 patients. Methods: Comprehensive literature search of PubMed, Embase, Web of Science and Cochrane Library databases from inception through April 22, 2022 was performed for all published studies that utilized IPVD in COVID-19 ARDS patients. The single arm studies and case series were combined for a 1-arm meta-analysis, and the 2-arm studies were combined for a 2-arm meta-analysis. Primary outcomes for the 1-arm and 2-arm meta-analyzes were change in pre- and post-IPVD P/F ratios and mortality, respectively. Secondary outcomes for the 1-arm meta-analysis were change in pre- and post-IPVD positive end-expiratory pressure (PEEP) and lung compliance, and for the 2-arm meta-analysis the secondary outcomes were need for endotracheal intubation and hospital length of stay (LOS). Results: 13 single arm retrospective studies and 5 case series involving 613 patients were included in the 1-arm meta-analysis. 3 studies involving 640 patients were included in the 2-arm meta-analysis. The pre-IPVD P/F ratios were significantly lower compared to post-IPVD, but there was no significant difference between pre- and post-IPVD PEEP and lung compliance. The mortality rates, need for endotracheal intubation, and hospital LOS were similar between the IPVD and standard therapy groups. Conclusion: Although IPVD may improve oxygenation, our investigation showed no benefits in terms of mortality compared to standard therapy alone. However, randomized controlled trials are warranted to validate our findings.

show abstract

Evaluation of Continuous Inhaled Epoprostenol in the Treatment of Acute Respiratory Distress Syndrome, Including Patients With SARS-CoV-2 Infection

Cited by 3 publications

References 49 publications

A Comparison of Inhaled Epoprostenol in Patients With Acute Respiratory Distress Syndrome and COVID-19-Associated Acute Respiratory Distress Syndrome

A Comparison of Inhaled Epoprostenol in Patients With Acute Respiratory Distress Syndrome and COVID-19-Associated Acute Respiratory Distress Syndrome

A Narrative Review on the Administration of Inhaled Prostaglandins in Critically Ill Adult Patients With Acute Respiratory Distress Syndrome

Inhaled Pulmonary Vasodilators in COVID-19 Infection: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About