Physiologic effect of inhaled epoprostenol versus inhaled nitric oxide Sarah Dobbins, Rathasen Prom, Jody Miller, Lindsay Harris Mission Hospital PGY1 Inpatient Care - Asheville, NC
Background/Purpose: Inhaled vasodilators are used to improve oxygen exchange, lower pulmonary artery pressure, and alleviate right heart stress. Inhaled epoprostenol (iEPO) has been used in place of nitric oxide (iNO) due to cost and administration concerns.
Methodology: This IRB-approved, retrospective chart review includes 187 adult patients admitted to Mission Hospital between January 2013 and August 2017 who received either iEPO or iNO for refractory hypoxemia, pulmonary hypertension, or cardiac support. Patients who received concomitant sildenafil were excluded. The primary outcome is the mean percent change in partial pressure of arterial oxygen to fraction of inspired oxygen (P/F) ratio for refractory hypoxemia, and mean percent change in pulmonary artery pressure (PAP) for pulmonary hypertension or cardiac support. Secondary outcomes include survival to hospital discharge and percent responders to therapy, defined as a 15% or greater change in P/F ratio or PAP. In addition, safety was evaluated in terms of number of blood units transfused.
Results: There was no difference in mean percent change in P/F ratio, but there was a statistically significant mean percent decrease in PAP in the iEPO arm (-3%±27 vs -27%±19, p=0.02.) There was a statistically significant increase in the percentage of responders in all patients (42.2% iNO vs 61.3% iEPO, p=0.04,) driven by the pulmonary hypertension/cardiac support group (23.1% iNO vs 76.9% iEPO, p=0.02.) There was no difference in survival to discharge or median units of blood products transfused.
Conclusions: iEPO is at least as effective as iNO for both refractory hypoxemia and pulmonary hypertension/cardiac support. Based on these results, iEPO appears to be more effective than iNO at lowering pulmonary artery pressure.
Presentation Objective: Compare the effectiveness of iEPO to iNO in pulmonary hypertension/cardiac support and refractory hypoxemia.
Self-Assessment: True or false: Based on this study, iEPO is more effective than iNO in refractory hypoxemia.
