Giuseppe
Emeritus
[Source: Chest, full text: (LINK). Abstract, edited.]
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Original Research| January 31, 2013
Iloprost Improves Gas Exchange in Patients with Pulmonary Hypertension and ARDS
Eva Sawheny, MD; Ashley L. Ellis, RN; Gary T. Kinasewitz, MD, FCCP
From the Division of Pulmonary and Critical Care Medicine, University of Oklahoma Health Sciences, Oklahoma City, Oklahoma (Sawheny, Ellis, Kinasewitz)
Corresponding author: Gary T. Kinasewitz, MD, University of Oklahoma Health Sciences Center, Chief, Pulmonary and Critical Care Medicine, Professor of Medicine, Physiology and Biophysics, 920 Stanton L. Young Blvd., WP 1310, Oklahoma City, OK 73104-5020, Gary-Kinasewitz@ouhsc.edu
Funding: Supported in part by a grant from Actelion Pharmaceuticals. The sponsor had no role in the study design, data interpretation or manuscript preparation.
CHEST. January 31, 2013doi:10.1378/chest.12-2296 - Published online
ABSTRACT:
AIMS AND OBJECTIVES:
We hypothesized that nebulized iloprost would improve ventilation perfusion matching in patients with pulmonary hypertension and acute respiratory distress syndrome (ARDS) as reflected by an improved PaO<SUB>2</SUB>/F<SUB>I</SUB>O<SUB>2</SUB> ratio and PaO<SUB>2</SUB> without adversely affecting lung mechanics or systemic hemodynamics.
METHODS:
ARDS patients with pulmonary hypertension were enrolled. With constant ventilator settings, hemodynamics, airway pressures and gas exchange measured at baseline were compared to values 30 min after 10 mcg nebulized Iloprost, and again 30 min after a second dose of 20 mcg of iloprost and finally 2 h after the second dose. The primary outcome variable was PaO2 while secondary outcomes were PaO<SUB>2</SUB>/F<SUB>I</SUB>O<SUB>2</SUB> ratio, mean arterial BP, and lung compliance ventilatory equivalents for O<SUB>2</SUB> and CO<SUB>2</SUB>.
RESULTS:
After informed consent was obtained 20 patients (9 male and 11 female, median age 59 ((IQR 44 to 66)) years, with ARDS were enrolled. Baseline PaO<SUB>2</SUB> improved from 82(?13) mmHg to 100(?25) and 100(?25) mmHg after the 1<SUP>st</SUP> and 2<SUP>nd</SUP> doses of iloprost respectively, while, PaO<SUB>2</SUB>/F<SUB>I</SUB>O<SUB>2</SUB> ratio of 177(?60) improved to 213(?67) and 212(?70) (all p<0.01). PaCO<SUB>2</SUB>, peak and plateau airway pressures, systemic blood pressure and heart rate were not significantly changed after iloprost.
CONCLUSIONS:
The improvement in gas exchange without any detrimental effects on pulmonary mechanics or systemic hemodynamics suggests nebulized iloprost may be a useful therapeutic agent to improve oxygenation in patients with ARDS.
ClinTrials.gov NCT01274481
-Iloprost Improves Gas Exchange in Patients with Pulmonary Hypertension and ARDS
Eva Sawheny, MD; Ashley L. Ellis, RN; Gary T. Kinasewitz, MD, FCCP
From the Division of Pulmonary and Critical Care Medicine, University of Oklahoma Health Sciences, Oklahoma City, Oklahoma (Sawheny, Ellis, Kinasewitz)
Corresponding author: Gary T. Kinasewitz, MD, University of Oklahoma Health Sciences Center, Chief, Pulmonary and Critical Care Medicine, Professor of Medicine, Physiology and Biophysics, 920 Stanton L. Young Blvd., WP 1310, Oklahoma City, OK 73104-5020, Gary-Kinasewitz@ouhsc.edu
Funding: Supported in part by a grant from Actelion Pharmaceuticals. The sponsor had no role in the study design, data interpretation or manuscript preparation.
CHEST. January 31, 2013doi:10.1378/chest.12-2296 - Published online
ABSTRACT:
AIMS AND OBJECTIVES:
We hypothesized that nebulized iloprost would improve ventilation perfusion matching in patients with pulmonary hypertension and acute respiratory distress syndrome (ARDS) as reflected by an improved PaO<SUB>2</SUB>/F<SUB>I</SUB>O<SUB>2</SUB> ratio and PaO<SUB>2</SUB> without adversely affecting lung mechanics or systemic hemodynamics.
METHODS:
ARDS patients with pulmonary hypertension were enrolled. With constant ventilator settings, hemodynamics, airway pressures and gas exchange measured at baseline were compared to values 30 min after 10 mcg nebulized Iloprost, and again 30 min after a second dose of 20 mcg of iloprost and finally 2 h after the second dose. The primary outcome variable was PaO2 while secondary outcomes were PaO<SUB>2</SUB>/F<SUB>I</SUB>O<SUB>2</SUB> ratio, mean arterial BP, and lung compliance ventilatory equivalents for O<SUB>2</SUB> and CO<SUB>2</SUB>.
RESULTS:
After informed consent was obtained 20 patients (9 male and 11 female, median age 59 ((IQR 44 to 66)) years, with ARDS were enrolled. Baseline PaO<SUB>2</SUB> improved from 82(?13) mmHg to 100(?25) and 100(?25) mmHg after the 1<SUP>st</SUP> and 2<SUP>nd</SUP> doses of iloprost respectively, while, PaO<SUB>2</SUB>/F<SUB>I</SUB>O<SUB>2</SUB> ratio of 177(?60) improved to 213(?67) and 212(?70) (all p<0.01). PaCO<SUB>2</SUB>, peak and plateau airway pressures, systemic blood pressure and heart rate were not significantly changed after iloprost.
CONCLUSIONS:
The improvement in gas exchange without any detrimental effects on pulmonary mechanics or systemic hemodynamics suggests nebulized iloprost may be a useful therapeutic agent to improve oxygenation in patients with ARDS.
ClinTrials.gov NCT01274481
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