Inhaled Prostacyclins for Acute Respiratory Distress Syndrome: A Systematic Review and Meta-Analysis

Abstract

OBJECTIVES:Studies evaluating inhaled prostacyclins for the management of acute respiratory distress syndrome (ARDS) have produced inconsistent results regarding their effect on oxygenation. The purpose of this systematic review and meta-analysis was to evaluate the change in the Pao 2 /Fio 2 ratio after administration of an inhaled prostacyclin in patients with ARDS. DATA SOURCES:We searched Ovid Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane, Scopus, and Web of Science. STUDY SELECTION:We included abstracts and trials evaluating administration of inhaled prostacyclins in patients with ARDS.DATA EXTRACTION: Change in the Pao 2 /Fio 2 ratio, Pao 2 , and mean pulmonary artery pressure (mPAP) were extracted from included studies. Evidence certainty and risk of bias were evaluated using Grading of Recommendations Assessment, Development, and Evaluation and the Cochrane Risk of Bias tool. DATA SYNTHESIS:We included 23 studies (1,658 patients) from 6,339 abstracts identified by our search strategy. The use of inhaled prostacyclins improved oxygenation by increasing the Pao 2 /Fio 2 ratio from baseline (mean difference [MD], 40.35; 95% CI, 26.14-54.56; p < 0.00001; I 2 = 95%; very low quality evidence). Of the eight studies to evaluate change in Pao 2 , inhaled prostacyclins also increased Pao 2 from baseline (MD, 12.68; 95% CI, 2.89-22.48 mm Hg; p = 0.01; I 2 = 96%; very low quality evidence). Only three studies evaluated change in mPAP, but inhaled prostacyclins were found to improve mPAP from baseline (MD, -3.67; 95% CI, -5.04 to -2.31 mm Hg; p < 0.00001; I 2 = 68%; very low quality evidence). CONCLUSIONS:In patients with ARDS, use of inhaled prostacyclins improves oxygenation and reduces pulmonary artery pressures. Overall data are limited and there was high risk of bias and heterogeneity among included studies. Future studies evaluating inhaled prostacyclins for ARDS should evaluate their role in ARDS subphenotypes, including cardiopulmonary ARDS.

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

“…69 When evaluated separately, inhaled prostaglandins improved oxygenation in patients with COVID-19-associated ARDS and non-COVID-19 ARDS as evidenced by increases in P/F ratio from baseline with mean differences of 19.45 and 33.83, respectively. 69 The impact of therapy on mortality was reported at an overall rate of 56.2%. 69…”

“…69 Among the entirety of the studies included, the use of inhaled prostaglandins resulted in an improvement in oxygenation and pulmonary artery pressures as evidenced by improvements from baseline in P/F ratio, PaO 2 , mean pulmonary arterial pressures. 69 When evaluated separately, inhaled prostaglandins improved oxygenation in patients with COVID-19-associated ARDS and non-COVID-19 ARDS as evidenced by increases in P/F ratio from baseline with mean differences of 19.45 and 33.83, respectively. 69 The impact of therapy on mortality was reported at an overall rate of 56.2%.…”

“…69 The inhaled prostaglandins utilized in the included studies were iEPO, inhaled alprostadil, and inhaled iloprost. 69 Overall, 23 studies were included, which assessed the effect of various inhaled prostaglandins on P/F ratio in patients with COVID-19-associated ARDS and non-COVID-19 ARDS. 69 Among the entirety of the studies included, the use of inhaled prostaglandins resulted in an improvement in oxygenation and pulmonary artery pressures as evidenced by improvements from baseline in P/F ratio, PaO 2 , mean pulmonary arterial pressures.…”

“…69 Overall, 23 studies were included, which assessed the effect of various inhaled prostaglandins on P/F ratio in patients with COVID-19-associated ARDS and non-COVID-19 ARDS. 69 Among the entirety of the studies included, the use of inhaled prostaglandins resulted in an improvement in oxygenation and pulmonary artery pressures as evidenced by improvements from baseline in P/F ratio, PaO 2 , mean pulmonary arterial pressures. 69 When evaluated separately, inhaled prostaglandins improved oxygenation in patients with COVID-19-associated ARDS and non-COVID-19 ARDS as evidenced by increases in P/F ratio from baseline with mean differences of 19.45 and 33.83, respectively.…”

“…68 Torbic et al completed a meta-analysis to assess the effects of inhaled prostaglandins on oxygenation in patients with ARDS. 69 The inhaled prostaglandins utilized in the included studies were iEPO, inhaled alprostadil, and inhaled iloprost. 69 Overall, 23 studies were included, which assessed the effect of various inhaled prostaglandins on P/F ratio in patients with COVID-19-associated ARDS and non-COVID-19 ARDS.…”