Severity of Hypoxemia and Other Factors That Influence the Response to Aerosolized Prostacyclin in ARDS

Kallet, Richard H; Burns, Gregory D; Zhuo, Hanjing; Ho, Kelly; Phillips, Justin Scott; Pangilinan, Lance; Yip, Vivian; Gomez, Antonio; Lipnick, Michael S

doi:10.4187/respcare.05268

Cited by 22 publications

(34 citation statements)

References 52 publications

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“…The other explanation might come from subjects’ baseline oxygenation. Kallet et al found that the baseline oxygenation was significantly related to ARDS patients’ response to iEPO while patients with lower baseline oxygenation had less response to iEPO [27]. In our study, all the subjects’ baseline SpO 2 /F I O 2 was ≤150, which was in the lowest group in Kallet et al’s study.…”

Section: Discussionsupporting

confidence: 39%

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Epoprostenol Delivered via High Flow Nasal Cannula for ICU Subjects with Severe Hypoxemia Comorbid with Pulmonary Hypertension or Right Heart Dysfunction

Harnois

Markos

et al. 2019

Pharmaceutics

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Inhaled epoprostenol (iEPO) has been utilized to improve oxygenation in mechanically ventilated subjects with severe hypoxemia, but the evidence for iEPO via high-flow nasal cannula (HFNC) is rare. Following approval by the institutional review board, this retrospective cohort study evaluated subjects who received iEPO via HFNC for more than 30 min to treat severe hypoxemia comorbid with pulmonary hypertension or right heart dysfunction between July 2015 and April 2018. A total of 11 subjects were enrolled in the study of whom 4 were male (36.4%), age 57.5 ± 22.1 years, and APACHE II score at ICU admission was 18.5 ± 5.7. Ten subjects had more than three chronic heart or lung comorbidities; seven of them used home oxygen. After inhaling epoprostenol, subjects’ SpO2/FIO2 ratio improved from 107.5 ± 26.3 to 125.5 ± 31.6 (p = 0.026) within 30–60 min. Five subjects (45.5%) had SpO2/FIO2 improvement >20%, which was considered as a positive response. Heart rate, blood pressure, and respiratory rate were not significantly different. Seven subjects did not require intubation, and seven subjects were discharged home. This retrospective study demonstrated the feasibility of iEPO via HFNC in improving oxygenation. Careful titration of flow while evaluating subjects’ response may help identify responders and avoid delaying other interventions. This study supports the need for a larger prospective randomized control trial to further evaluate the efficacy of iEPO via HFNC in improving outcomes.

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Section: Discussionsupporting

confidence: 39%

“…In Kallet et al’s study on mechanical ventilation, 208 ARDS subjects were included, and only 62% responded to iEPO. The response rate decreased if the primary source of ARDS was lung related [27]. This finding might explain the low response rate (45%) in our study as all of the subjects had pulmonary etiology.…”

Section: Discussionmentioning

confidence: 71%

Epoprostenol Delivered via High Flow Nasal Cannula for ICU Subjects with Severe Hypoxemia Comorbid with Pulmonary Hypertension or Right Heart Dysfunction

Harnois

Markos

et al. 2019

Pharmaceutics

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“…Jedoch wurde auch hier keine Zunahme der Überlebensrate beobachtet. Vielmehr wird ebenfalls der pulmonal-vaskuläre Widerstand gesenkt, jedoch besteht gleichzeitig die Gefahr einer systemischen Kreislaufinstabilität durch arterielle Hypotension [69].…”

Section: Statineunclassified

ARDS – Ein Update – Teil 2: Therapie und Outcome

Dembinski¹,

Mielck²

2018

Anästhesiol Intensivmed Notfallmed Schmerzther

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The Acute Respiratory Distress Syndrome (ARDS) is defined by hypoxemic respiratory failure due to inflammatory response within the lung usually requiring invasive mechanical ventilation. Despite more than 50 years of scientific research numerous issues especially regarding mechanical ventilation as the most important treatment option remain unclear. Most important, adjustment of mechanical ventilation is challenging due to desirable beneficial effects on pulmonary gas exchange on the one hand and deleterious effects in terms of ventilator-associated lung injury on the other. Specifically, optimal settings of positive end-expiratory pressure and the role of spontaneous breathing activity are still controversial. Because no specific pharmacological therapy revealed beneficial effects until today, adjunctive treatment is actually limited to prone positioning and restrictive fluid balance. Long-term outcome of ARDS survivors is often affected by anxiety and mental health disorders.

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“…2,[5][6][7][8] Alternative strategies such as conservative fluid management, corticosteroids, and extracorporeal membrane oxygenation (ECMO) have resulted in improved oxygenation and lung compliance only. 2,[9][10][11] Inhaled epoprostenol and nitric oxide have been evaluated in refractory hypoxemia with comparable outcomes; significant cost savings have been associated with epoprostenol. 12,13 To reduce practice variation and improve outcomes, an inhaled epoprostenol utilization policy was implemented.…”

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confidence: 99%

Inhaled epoprostenol utilization pattern after implementation of an administration policy

Collier

Kataria

Modrykamien

2019

Baylor University Medical Center Proceedings

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Epoprostenol, a pulmonary vasodilator, is used to reduce pulmonary artery pressure. Its inhaled administration results in ventilation and perfusion matching with oxygenation improvement. Epoprostenol is used as treatment for various conditions, particularly acute respiratory distress syndrome (ARDS) and pulmonary arterial hypertension. In 2018, Baylor University Medical Center implemented a policy for inhaled epoprostenol utilization aimed at standardizing clinical practice. This study analyzed epoprostenol utilization patterns in patients with ARDS after implementation of this administration policy. Drug responders and nonresponders were compared for clinical outcomes and physiologic changes before and after use, and policy compliance was evaluated. Of 79 eligible patients, 30 fulfilled inclusion criteria: 14 (47%) had ARDS and 16 (53%) had non-ARDS. In all patients with ARDS, epoprostenol was a second rescue agent after neuromuscular blockade, prone positioning, corticosteroids, and extracorporeal membrane oxygenation. Epoprostenol was associated with statistically significant improvement of oxygenation before and after utilization in patients with ARDS (ratio of arterial oxygen partial pressure to fractional inspired oxygen 70 vs 140, respectively; P ¼ 0.04). Overall, 10 (71%) ARDS patients were epoprostenol responders; 9 (56%) were deemed responders among subjects with non-ARDS. Comparison of outcomes between responders and nonresponders showed no statistically significant variations. Policy compliance was obtained in 24 (80%) patients.

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Severity of Hypoxemia and Other Factors That Influence the Response to Aerosolized Prostacyclin in ARDS

Abstract: Aerosolized prostaglandin I improves oxygenation in approximately 60% of ARDS cases. A favorable response was most strongly associated with baseline P /F and C.

Cited by 22 publications

References 52 publications

Epoprostenol Delivered via High Flow Nasal Cannula for ICU Subjects with Severe Hypoxemia Comorbid with Pulmonary Hypertension or Right Heart Dysfunction

Epoprostenol Delivered via High Flow Nasal Cannula for ICU Subjects with Severe Hypoxemia Comorbid with Pulmonary Hypertension or Right Heart Dysfunction

ARDS – Ein Update – Teil 2: Therapie und Outcome

Inhaled epoprostenol utilization pattern after implementation of an administration policy

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