title: Inhaled prostacyclin (PGI2) is an effective addition to the treatment of pulmonary hypertension and hypoxia in the operating room and intensive care unit.
abstract: OBJECTIVE
  There is a growing interest in the intraoperative and intensive care use of inhaled epoprostenol (PGI2) for the treatment of pulmonary hypertension (PHT) and hypoxia of cardiac or non-cardiac origin. We report our experience with this form of therapy.
  
  
  METHODS
  A retrospective chart review of all patients who received inhaled PGI2 over a one-year period was undertaken. Demographic, hemodynamic, oxygenation status, mode of administration, side effects, duration of hospital stay, and mortality were noted.
  
  
  RESULTS
  Thirty-five patients, of which 33 (92%) were in the intensive care unit, received inhaled PGI2. Of the 27 patients whose pulmonary artery pressure (PAP) was monitored, a significant decrease in mean PAP from 34.8 +/- 11.8 mmHg to 32.1 +/- 11.8 mmHg was observed within one hour after the start of therapy (P=0.0017). Selective pulmonary vasodilatation occurred in 77.8% of the patients. Thirty-three patients had arterial blood gases before and after therapy. There was an improvement in the PaO2/FIO2 ratio in 88% of these with a 175% improvement on average. The ratio of PaO2/FIO2 improved from 108 +/- 8 to 138 +/- 105 (P=0.001). Six patients (17%) presented hypotension, two had subsequent pneumothorax, one had bronchospasm and in one patient PGI2 inhalation was stopped because of increasing peak pulmonary pressures from the secondary flow coming from the nebulizer. Mortality of the cohort was 54%.
  
  
  CONCLUSIONS
  Inhaled PGI2 can be useful in the treatment of patients with PHT and severe hypoxia. It can however be associated with systemic side effects.
authors.affiliation: Department of Anesthesiology, Montreal Heart Institute, Centre Hospitalier de l'Université de Montréal, Campus Notre-Dame, Montreal, Quebec, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Haché
authors.forename: A Y
authors.initials: AY
authors.lastname: Denault
authors.forename: S
authors.initials: S
authors.lastname: Bélisle
authors.forename: P
authors.initials: P
authors.lastname: Couture
authors.forename: D
authors.initials: D
authors.lastname: Babin
authors.forename: F
authors.initials: F
authors.lastname: Tétrault
authors.forename: J G
authors.initials: JG
authors.lastname: Guimond
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D011464:Epoprostenol / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D000860:Hypoxia / Q000188:drug therapy*; D007362:Intensive Care Units; D007430:Intraoperative Care; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents; D011464:Epoprostenol