Inhaled prostanoids may improve ventilation/perfusion matching in intubated ICU patients with PAH, though universal dosing recommendations are currently lacking.
May warrant cautious use in ventilated pediatric PAH pending dosing guidance; leaves open need for standardized trials.
The prostacyclins-prostanoids were one of the first medications used to treat pulmonary arterial hypertension (PAH). Three prostanoids have been developed to treat PAH: epoprostenol, treprostinil, and iloprost. In the acute setting, experience is growing, using the inhaled forms of these three medications. Inhalation may improve ventilation/perfusion matching, whereas in the intravenous form these medications may cause nonselective pulmonary vasodilation and may worsen ventilation/perfusion matching. Currently, there are no universal recommendations for dosing delivery of inhaled prostanoids to intubated patients in the intensive care unit setting.
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D. Dunbar Ivy (2010) studied this question.
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