title: Inhaled epoprostenol improves oxygenation in severe hypoxemia.
abstract: BACKGROUND
  Epoprostenol (Flolan), an inhalational epoprostenol vasodilator, increases pulmonary arterial flow and decreases pulmonary pressures, thereby improving gas exchange and arterial oxygenation. We evaluated the benefits of inhaled epoprostenol as a less expensive alternative to nitric oxide in ventilated surgical intensive care patients with severe hypoxemia.
  
  
  METHODS
  After institutional review board approval was obtained, the records of mechanically ventilated surgical intensive care unit patients who received epoprostenol as a therapy for severe hypoxia (SaO₂ < 90%) in a tertiary care referral center were retrospectively reviewed. Initial PaO₂/FIO₂ (P/F) ratio and oxygen saturation were compared with values at 12 and 48 hours after the administration of epoprostenol. One-way repeated-measures analysis of variance compared improvements in oxygenation. Further subgroup analyses evaluated differences among trauma, nontrauma patient subgroups, time to initiation of epoprostenol, and age.
  
  
  RESULTS
  During a 20 month-interval beginning February 2009, 36 patients (23 trauma and 13 nontrauma; age, 15-80 years) were treated. Epoprostenol significantly improved both P/F ratio and oxygen saturation in both trauma and nontrauma patients. Therewas no difference between subgroups. Larger improvements in P/F ratiowere seen when epoprostenolwas started within 7 days. Response between age groups did not differ significantly. Subgroup analysis of mortality (trauma, 60.9% vs. nontrauma, 61.5%) failed to show any differences.
  
  
  CONCLUSIONS
  Treatment with inhaled epoprostenol improved gas exchange in severely hypoxemic surgical patients. Earlier intervention (within 7 days of intubation) was more efficacious at improving oxygenation.
authors.affiliation: Department of Surgery, University of Florida Health Sciences Center, Jacksonville, Florida, USA.
authors.forename: Maryam Bita
authors.initials: MB
authors.lastname: Tabrizi
authors.forename: Miren A
authors.initials: MA
authors.lastname: Schinco
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Tepas
authors.forename: James
authors.initials: J
authors.lastname: Hwang
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Spiwak
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerwin
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016638:Critical Illness; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000187:drug effects*; D011652:Pulmonary Circulation / Q000187:drug effects; D011659:Pulmonary Gas Exchange / Q000187:drug effects*; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D055815:Young Adult
chemical_list: D014665:Vasodilator Agents; D011464:Epoprostenol