Randomized controlled trial of aerosolized prostacyclin therapy in children with acute lung injury*

Dahlem, Peter; Aalderen, W. M. C. van; Neef, Marjorie de; Dijkgraaf, Marcel G. W.; Bos, Albert P.

doi:10.1097/01.ccm.0000120055.52377.bf

Cited by 73 publications

(69 citation statements)

References 39 publications

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“…Primary outcome measure was oxygenation. It was found that oxygenation was significantly improved by 26% [143]. The optimal dosage in children for PGI 2 was 30 ng/kg/min and thus higher than the recommended dosage in adult patients of 10 ng/kg/min [145;146].…”

Section: Aerosolized Prostacyclinsmentioning

confidence: 99%

Pediatric acute lung injury

Dahlem

Aalderen

Bos

2007

Paediatric Respiratory Reviews

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Section: Aerosolized Prostacyclinsmentioning

confidence: 99%

Pediatric acute lung injury

Dahlem

Aalderen

Bos

2007

Paediatric Respiratory Reviews

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“…But although the use of iEPO has gained popularity since it was first publicized for the treatment of ARDS in 1993, substantial efficacy data are lacking [Walmrath et al 1993]. Literature evaluating its use have been few and thus no studies have evaluated mortality as a primary endpoint [Zwissler et al 1996;Walmrath et al 1996;van Heerden et al 2000;Dunkley et al 2013;Domenighetti et al 2001;Dahlem et al 2004]. While commonly used as a therapy of final resort, a gap in the literature has led to controversy surrounding iEPO in regards to optimal dosing and safety, as well as the target patient population.…”

Section: Introductionmentioning

confidence: 99%

“…Epoprostenol initiates a cascade resulting in vasodilation of pulmonary vascular beds promoting blood flow to areas of active ventilation [Zwissler et al 1996]. While certain strategies such as protective lung ventilation, prone positioning and neuromuscular blockade have literature suggesting benefit in ARDS patients, SPVs have failed to do so in clinical research and are commonly reserved for patients failing to respond to these therapies [Papazian et al 2010;Slutsky, 2010;Beitler et al 2014;Goffi and Ferguson, 2014;The ARDS Network, 2000;Walmrath et al 1996;van Heerden et al 2000;Dunkley et al 2013;Domenighetti et al 2001;Dahlem et al 2004;Torbic et al 2013].…”

Section: Introductionmentioning

confidence: 99%

“…Although iNO improves oxygenation, its cost, need for sophisticated equipment and potential systemic side effects limits its judicious use and promotes the demand for alternative therapies [Zwissler et al 1996;Walmrath et al 1996;van Heerden et al 2000;Dunkley et al 2013;Dahlem et al 2004;Domenighetti et al 2001]. iEPO has been suggested as an alternative to iNO due to its similar efficacy, lower potential for systemic side effects, ease of administration and substantially lower cost [Zwissler et al 1996].…”

Section: Introductionmentioning

confidence: 99%

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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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“…In particular, iloprost was as efficacious as iNO for infants with pulmonary hypertension and congenital heart defects but was not synergistic with iNO [61]. 14 infants and children with acute lung injury received nebulised epoprostenol and oxygenation improved with NNT 51.8 [63]. Since all these molecules are liquid, nebulisation is needed.…”

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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Randomized controlled trial of aerosolized prostacyclin therapy in children with acute lung injury*

Abstract: Aerosolized prostacyclin improves oxygenation in children with acute lung injury. Future trials should investigate whether this treatment will positively affect outcome.

Cited by 73 publications

References 39 publications

Pediatric acute lung injury

Pediatric acute lung injury

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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