Giuseppe
Emeritus
[Source: Chest, full page: (LINK). Abstract, edited.]
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Original Research | July 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, OK.
Correspondence to: Gary T. Kinasewitz, MD, FCCP, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd, WP 1310, Oklahoma City, OK 73104-5020; e-mail: Gary-Kinasewitz@ouhsc.edu
Funding/Support: This study was supported in part by a grant from Actelion Pharmaceuticals Ltd.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.
Chest. 2013; 144(1):55-62. doi:10.1378/chest.12-2296 - Published online
Abstract
Objective:
We hypothesized that nebulized iloprost would improve ventilation-perfusion matching in patients with pulmonary hypertension and ARDS as reflected by an improved Pao<SUB>2</SUB>/Fio<SUB>2</SUB> ratio and Pao<SUB>2</SUB> without adversely affecting lung mechanics or systemic hemodynamics.
Methods:
Patients with ARDS and pulmonary hypertension were enrolled. With constant ventilator settings, hemodynamics, airway pressures, and gas exchange measured at baseline were compared with values 30 min after administration of 10 μg nebulized iloprost, and again 30 min after a second, larger, 20 μg dose of iloprost, and then a final measurement 2 h after the second dose. The primary outcome variable was Pao<SUB>2</SUB>; secondary outcomes were Pao<SUB>2</SUB>/Fio<SUB>2</SUB> ratio, mean arterial BP, and lung-compliance ventilatory equivalents for oxygen and CO<SUB>2</SUB>.
Results:
After informed consent was obtained, 20 patients (nine men, 11 women; median age, 59 years [interquartile range, 44-66 years]) with ARDS were enrolled. Baseline Pao<SUB>2</SUB> improved from a mean (? SD) of 82 (13) mm Hg to 100 (25) mm Hg after both the first and second doses of iloprost, and the baseline mean (? SD) Pao<SUB>2</SUB>/Fio<SUB>2</SUB> ratio of 177 (60) improved to 213 (67) and 212 (70) (all P < .01). Paco<SUB>2</SUB>, peak and plateau airway pressures, systemic BP, 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.
Trial registry:
ClinicalTrials.gov; No.: NCT01274481; URL: www.clinicaltrials.gov
-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, OK.
Correspondence to: Gary T. Kinasewitz, MD, FCCP, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd, WP 1310, Oklahoma City, OK 73104-5020; e-mail: Gary-Kinasewitz@ouhsc.edu
Funding/Support: This study was supported in part by a grant from Actelion Pharmaceuticals Ltd.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.
Chest. 2013; 144(1):55-62. doi:10.1378/chest.12-2296 - Published online
Abstract
Objective:
We hypothesized that nebulized iloprost would improve ventilation-perfusion matching in patients with pulmonary hypertension and ARDS as reflected by an improved Pao<SUB>2</SUB>/Fio<SUB>2</SUB> ratio and Pao<SUB>2</SUB> without adversely affecting lung mechanics or systemic hemodynamics.
Methods:
Patients with ARDS and pulmonary hypertension were enrolled. With constant ventilator settings, hemodynamics, airway pressures, and gas exchange measured at baseline were compared with values 30 min after administration of 10 μg nebulized iloprost, and again 30 min after a second, larger, 20 μg dose of iloprost, and then a final measurement 2 h after the second dose. The primary outcome variable was Pao<SUB>2</SUB>; secondary outcomes were Pao<SUB>2</SUB>/Fio<SUB>2</SUB> ratio, mean arterial BP, and lung-compliance ventilatory equivalents for oxygen and CO<SUB>2</SUB>.
Results:
After informed consent was obtained, 20 patients (nine men, 11 women; median age, 59 years [interquartile range, 44-66 years]) with ARDS were enrolled. Baseline Pao<SUB>2</SUB> improved from a mean (? SD) of 82 (13) mm Hg to 100 (25) mm Hg after both the first and second doses of iloprost, and the baseline mean (? SD) Pao<SUB>2</SUB>/Fio<SUB>2</SUB> ratio of 177 (60) improved to 213 (67) and 212 (70) (all P < .01). Paco<SUB>2</SUB>, peak and plateau airway pressures, systemic BP, 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.
Trial registry:
ClinicalTrials.gov; No.: NCT01274481; URL: www.clinicaltrials.gov
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