Key result
Aerosolized prostacyclin administration significantly decreased mean pulmonary blood pressure from 41.2 to 36.1 mm Hg (p < 0.05) in patients with severe respiratory failure.
Why the study?
Does aerosolized epoprostenol improve hemodynamics and pulmonary gas exchange in patients with severe respiratory failure and acute pulmonary hypertension?
Does aerosolized epoprostenol improve hemodynamics and pulmonary gas exchange in patients with severe respiratory failure and acute pulmonary hypertension?
Absolute Event Rate: 36.1% vs 41.2%
p-value: p=< 0.05
Aerosolized epoprostenol provides beneficial selective pulmonary vasodilatation, improving hemodynamics and oxygenation in patients with severe respiratory failure and acute pulmonary hypertension.
May support selective pulmonary vasodilation in acute pulmonary hypertension; hypothesis-generating and requires randomized confirmation before clinical adoption.
We investigated the effects of aerosolized prostacyclin (PGI2) administration on hemodynamics and pulmonary gas exchange in 8 patients with severe respiratory failure and acute pulmonary hypertension. Nebulization of epoprostenol (5 ng/kg body weight for 15 min) decreased mean pulmonary blood pressure from 41.2 +/- 6.7 mm Hg (mean +/- SD, before administration) to 36.1 +/- 6 mm Hg < or = 15 min (p < 0.05). The effect was reversed 10 min after discontinuation of PGI2 (40.9 +/- 6.3 mm Hg). Pulmonary vascular resistance index (339 +/- 138 dynes.s.cm-5.m2, before administration) was significantly (p < 0.05) reduced < or = 15 min (260 +/- 89 dynes.s.cm-5.m2) and increased again after discontinuation of PGI2 (341 +/- 142 dynes.s.cm-5.m2). The ratio of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) increased from 119 +/- 34 mm Hg (before administration) to 163 +/- 76 mm Hg (15 min after initiation of administration p < 0.05) and was reduced after PGI2 discontinuation (116 +/- 35 mm Hg). Heart rate, mean blood pressure, central venous pressure, and pulmonary arterial wedge pressure remained unchanged, whereas cardiac index was slightly reduced. We assume that PGI2 aerosolization is a beneficial technique, applied with a ventilator nebulization system. The beneficial effect might be caused by selective pulmonary vasodilatation in well-ventilated areas of the lung.
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Bein et al. (1996) studied Severe respiratory failure and acute pulmonary hypertension (n=8). Aerosolized prostacyclin (PGI2) / epoprostenol vs. Baseline (before administration) was evaluated on Mean pulmonary blood pressure (p=< 0.05). Aerosolized prostacyclin administration significantly decreased mean pulmonary blood pressure from 41.2 to 36.1 mm Hg (p < 0.05) in patients with severe respiratory failure.
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