title: Inhaled aerosolized prostacyclin as a selective pulmonary vasodilator for the treatment of severe hypoxaemia.
abstract: Two case reports are presented where inhaled aerosolized prostacyclin (IAP) was used to good effect as a selective pulmonary vasodilator. It was used in the treatment of a patient with severe hypoxaemia secondary to amniotic fluid embolism and for hypoxaemia secondary to the acute respiratory distress syndrome (ARDS) in a patient with acute on chronic liver failure and intra-abdominal sepsis. An apparent dose-response curve is demonstrated in the second case. A dose of IAP of 30-40 ng/kg/min produced an effect on oxygenation in the patient with liver failure equal to that seen at the maximal dose of (50 ng/kg/min). Reduction in dose below 30 ng/kg/min resulted in a deterioration in oxygenation towards baseline/pre-treatment levels. Inhaled aerosolized prostacyclin is a potent pulmonary vasodilator with little or no systemic hypotensive effect. It is simple to administer and would appear to be a viable alternative to inhaled nitric oxide.
authors.affiliation: Department of Intensive Care, Sir Charles Gairdner Hospital, Perth, Western Australia.
authors.forename: P V
authors.initials: PV
authors.lastname: Van Heerden
authors.forename: S A
authors.initials: SA
authors.lastname: Webb
authors.forename: G
authors.initials: G
authors.lastname: Hee
authors.forename: M
authors.initials: M
authors.lastname: Corkeron
authors.forename: W R
authors.initials: WR
authors.lastname: Thompson
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000336:Aerosols; D004619:Embolism, Amniotic Fluid / Q000150:complications; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D000860:Hypoxia / Q000188:drug therapy* / Q000209:etiology; D008168:Lung / Q000098:blood supply / Q000187:drug effects; D011247:Pregnancy; D012128:Respiratory Distress Syndrome / Q000150:complications; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D000336:Aerosols; D014665:Vasodilator Agents; D011464:Epoprostenol