Iloprost as ‘rescue’ therapy for pulmonary hypertension of the neonate

Luca, Danièle De; Zecca, Enrico; Piastra, Marco; Romagnoli, Costantino

doi:10.1111/j.1460-9592.2006.02104.x

Cited by 42 publications

(53 citation statements)

References 14 publications

(23 reference statements)

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“…The combined use of these drugs may be successful in treating pulmonary hypertension when a single drug fails. 14 However, the improvement in hypoxemia in our patient did not correlate with improvement in RVSP/BP and pulmonary vasodilation. Previous reports of neonates treated with iPGI 2 have shown significant improvement in oxygenation without demonstrating an improvement in RVSP.…”

Section: Discussioncontrasting

confidence: 70%

Can inhaled prostacyclin stimulate surfactant in ELBW infants?

et al. 2007

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Respiratory distress syndrome (RDS) causes significant hypoxia in extremely low birth weight (ELBW) infants. We report an ELBW infant with RDS and pulmonary hypertension whose hypoxia did not respond to inhaled nitric oxide but improved with inhaled prostacyclin. We propose that inhaled prostacyclin alleviated the hypoxia by stimulating surfactant secretion. (2007) 27, 724-726; doi:10.1038/sj.jp.7211811 Journal of PerinatologyKeywords: persistent pulmonary hypertension; hypoxia; respiratory distress syndrome; prostacyclin; surfactant; extremely-low-birth-weight infant Background Hypoxemia is a feature of respiratory distress syndrome. Patent ductus arteriosus (PDA) and persistent pulmonary hypertension of the newborn (PPHN) can exacerbate hypoxemia. Inhaled nitric oxide (iNO) is effective for treatment of PPHN in full-term infants by decreasing pulmonary vascular resistance, thereby decreasing right-to-left shunting and alleviating hypoxemia. Several case reports have similarly shown that inhaled prostacyclin (iPGI 2 ) is effective through pulmonary vasodilation in full-term and preterm infants with PPHN. 1-5 Hypoxemia in our patient was refractory to iNO but improved with iPGI 2 . We propose that this response may be due to a physiological mechanism different from pulmonary vasodilatation.

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Section: Discussioncontrasting

confidence: 70%

Can inhaled prostacyclin stimulate surfactant in ELBW infants?

et al. 2007

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“…An early case series proposed benefit of using inhaled iloprost as rescue therapy in two neonatal patients. Initially, both patients showed dramatic improvement in oxygenation, but despite best efforts to save them, both patients died within 3 weeks of initiating iloprost [De Luca et al 2007]. …”

Section: Iloprostmentioning

confidence: 99%

The role of inhaled prostacyclin in treating acute respiratory distress syndrome

Searcy

Morales

Ferreira

et al. 2015

Ther Adv Respir Dis

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Acute respiratory distress syndrome (ARDS) is a syndrome of acute lung injury that is characterized by noncardiogenic pulmonary edema and severe hypoxemia second to a pathogenic impairment of gas exchange. Despite significant advances in the area, mortality remains high among ARDS patients. High mortality and a limited spectrum of therapeutic options have left clinicians searching for alternatives, spiking interest in selective pulmonary vasodilators (SPVs). Despite the lack of robust evidence, SPVs are commonly employed for their therapeutic role in improving oxygenation in patients who have developed refractory hypoxemia in ARDS. While inhaled epoprostenol (iEPO) also impacts arterial oxygenation by decreasing ventilation-perfusion (V/Q) mismatching and pulmonary shunt flow, this effect is not different from inhaled nitric oxide (iNO). The most effective and safest dose for yielding a clinically significant increase in PaO 2 and reduction in pulmonary artery pressure (PAP) appears to be 20-30 ng/kg/min in adults and 30 ng/kg/min in pediatric patients. iEPO appears to have a ceiling effect above these doses in which no additional benefit may be derived. iNO and iEPO have shown similar efficacy profiles; however, they differ with respect to cost and ease of therapeutic administration. The most beneficial effects of iEPO have been seen in adult patients with secondary ARDS as compared with primary ARDS, most likely due to the difference in etiology of the two disease states, and in patients suffering from baseline right ventricular heart failure. Although iEPO has demonstrated improvements in hemodynamic parameters and oxygenation in ARDS patients, due to the limited number of randomized clinical trials and the lack of studies investigating mortality, the use of iEPO cannot be recommended as standard of care in ARDS. iEPO should be reserved for those refractory to traditional therapies.

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“…Iloprost is a synthetic carbacyclin analogue which has a longer half-life than epoprostenol with fewer rebounds after the administration and is available in a neutral solution [59]. Iloprost has been used in six term and pre-term babies, alone or together with iNO, and significantly improved oxygenation [57,60].…”

Section: Pulmonary Vasodilatorsmentioning

confidence: 99%

“…All babies survived except for one with alveolar capillary dysplasia. Epoprostenol is provided in an alkaline buffer that could theoretically harm the lung epithelium [57]. A synthetic PGE 1 has also been used in 20 neonates with promising results [58].…”

Section: Pulmonary Vasodilatorsmentioning

confidence: 99%

Intrapulmonary drug administration in neonatal and paediatric critical care: a comprehensive review

Luca

Cogo²,

Zecca³

et al. 2011

European Respiratory Journal

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Administration of drugs directly into the respiratory tree first was proposed a long time ago. Surfactant is the paradigmatic example of such therapies. Many other drugs have been used in the same way and further compounds are under investigation for this aim. In the last two decades, despite the wide number of drugs available for direct lung administration in critical care patients, few controlled data exist regarding their use in neonates and infants.This review will focus on drugs clinically available in a critical care setting for neonates and infants, including bronchodilators, pulmonary vasodilators, anti-inflammatory agents, mucolytics, resuscitative anti-infective agents, surfactants and other drugs.We provide an evidence-based comprehensive review of drugs available for intratracheal administration in paediatric and neonatal critical care and we examine possible advantages and risks for each proposed indication.

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Iloprost as ‘rescue’ therapy for pulmonary hypertension of the neonate

Cited by 42 publications

References 14 publications

Can inhaled prostacyclin stimulate surfactant in ELBW infants?

Can inhaled prostacyclin stimulate surfactant in ELBW infants?

The role of inhaled prostacyclin in treating acute respiratory distress syndrome

Intrapulmonary drug administration in neonatal and paediatric critical care: a comprehensive review

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