Predictors of Outcome in 216 Subjects With ARDS Treated With Inhaled Epoprostenol

Pacheco, Jose M.; Arnold, Heather; Skrupky, Lee P.; Watts, Peggy; Micek, Scott T.; Kollef, Marin H.

doi:10.4187/respcare.02939

Cited by 22 publications

(34 citation statements)

References 38 publications

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“…21 Another study investigating the outcome of 216 ARDS patients treated with inhaled epoprostenol had the similar finding that hospital mortality was significantly associated with an incremental change in PaO 2 /FiO 2 during the first 24 h of treatment (adjusted OR: 0.99, 95% CI: 0.988–0.994, P = 0.002). 22 Therefore, these findings suggest that the change of PaO 2 /FiO 2 may be another good predictor of outcome in patients with ARDS.…”

Section: Discussionmentioning

confidence: 78%

“…In Gong et al, 23 age was a significant predictor of mortality with adjusted OR of 1.96 (95% CI: 1.50–2.53). In Pacheco et al, 22 the addition of cumulative fluid balance of >4 L was an independent predictor (adjusted OR: 2.36, 95% CI: 1.66–3.37, P = 0.02). In Zhang and Chen, 24 positive fluid balance in the first 8 days was significantly associated with increased risk of death after stepwise regression analysis (OR: 1.00057; 95% CI: 1.00034–1.00080).…”

Section: Discussionmentioning

confidence: 86%

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The Ratio of Partial Pressure Arterial Oxygen and Fraction of Inspired Oxygen 1 Day After Acute Respiratory Distress Syndrome Onset Can Predict the Outcomes of Involving Patients

et al. 2016

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The initial hypoxemic level of acute respiratory distress syndrome (ARDS) defined according to Berlin definition might not be the optimal predictor for prognosis. We aimed to determine the predictive validity of the stabilized ratio of partial pressure arterial oxygen and fraction of inspired oxygen (PaO2/FiO2 ratio) following standard ventilator setting in the prognosis of patients with ARDS.This prospective observational study was conducted in a single tertiary medical center in Taiwan and compared the stabilized PaO2/FiO2 ratio (Day 1) following standard ventilator settings and the PaO2/FiO2 ratio on the day patients met ARDS Berlin criteria (Day 0). Patients admitted to intensive care units and in accordance with the Berlin criteria for ARDS were collected between December 1, 2012 and May 31, 2015. Main outcome was 28-day mortality. Arterial blood gas and ventilator setting on Days 0 and 1 were obtained.A total of 238 patients met the Berlin criteria for ARDS were enrolled, and they were classified as mild (n = 50), moderate (n = 125), and severe (n = 63) ARDS, respectively. Twelve (5%) patients who originally were classified as ARDS did not continually meet the Berlin definition, and a total of 134 (56%) patients had the changes regarding the severity of ARDS from Day 0 to Day 1. The 28-day mortality rate was 49.1%, and multivariate analysis identified age, PaO2/FiO2 on Day 1, number of organ failures, and positive fluid balance within 5 days as significant risk factors of death. Moreover, the area under receiver-operating curve for mortality prediction using PaO2/FiO2 on Day 1 was significant higher than that on Day 0 (P = 0.016).PaO2/FiO2 ratio on Day 1 after applying mechanical ventilator is a better predictor of outcomes in patients with ARDS than those on Day 0.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 86%

The Ratio of Partial Pressure Arterial Oxygen and Fraction of Inspired Oxygen 1 Day After Acute Respiratory Distress Syndrome Onset Can Predict the Outcomes of Involving Patients

et al. 2016

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“…Through logistic regression, Pacheo and colleagues noted that trauma, as the etiology of ARDS, was independently associated with a lower risk of hospital mortality [Pacheco et al 2014]. This study, however, is retrospective in nature and is only able to provide an association.…”

Section: Patient Populationsmentioning

confidence: 70%

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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“…26,27, Two studies were RCTs, six were prospective, nonrandomized interventional studies, 10 were observational studies, and seven were case series. Th e total number of patients across studies was 606 (n 5 497 epoprostenol, n 5 109 alprostadil, median 11 patients per study).…”

Section: Study Characteristics and Outcomes Reportingmentioning

confidence: 99%

“…20 Stratifi ed subgroup analyses were performed, as were sensitivity analyses, which excluded the study with the largest mean diff erence in Pa o 2 to F io 2 ratio and the largest number of patients. 26,27 Heterogeneity between studies was assessed using the I 2 statistic, with suggested thresholds for low (25%-49%), moderate (50%-74%), and high ( Ն 75%) values. 28,29 During the systematic review, it was evident that the secondary outcomes (mortality and adverse eff ects) could not be assessed quantitatively.…”

Section: Meta-analysismentioning

confidence: 99%

The Use of Inhaled Prostaglandins in Patients With ARDS

Fuller

Mohr

Skrupky

et al. 2015

Chest

112

124

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Predictors of Outcome in 216 Subjects With ARDS Treated With Inhaled Epoprostenol

Cited by 22 publications

References 38 publications

The Ratio of Partial Pressure Arterial Oxygen and Fraction of Inspired Oxygen 1 Day After Acute Respiratory Distress Syndrome Onset Can Predict the Outcomes of Involving Patients

The Ratio of Partial Pressure Arterial Oxygen and Fraction of Inspired Oxygen 1 Day After Acute Respiratory Distress Syndrome Onset Can Predict the Outcomes of Involving Patients

The role of inhaled prostacyclin in treating acute respiratory distress syndrome

The Use of Inhaled Prostaglandins in Patients With ARDS

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