title: Efficacy, safety, and medication errors associated with the use of inhaled epoprostenol for adults with acute respiratory distress syndrome: a pilot study.
abstract: BACKGROUND
  Acute respiratory distress syndrome (ARDS) is a type of hypoxic respiratory failure that results from ventilation and perfusion mismatching. Inhaled epoprostenol induces relaxation of smooth muscle in pulmonary vasculature, leading to improved oxygenation.
  
  
  OBJECTIVE
  To determine if the use of inhaled epoprostenol produced a 10% or greater increase in the ratio of arterial partial pressure of oxygen (PaO₂) to fraction of inspired oxygen (FiO₂) in ARDS patients and to review adverse events and medication errors.
  
  
  METHODS
  An observational chart review was performed based on a report generated from the electronic medical record system. Patients who received at least 1 dose of inhaled epoprostenol from January 1, 2008, to December 31, 2010, at any hospital within the Florida Hospital Health System were considered for inclusion. Demographics, dose, duration of therapy, adverse effects, medication errors, and outcomes data were collected.
  
  
  RESULTS
  Sixteen patients were included in the study. Oxygenation improved by 10% or more in 62.5% (10/16) of the patients, with an initial (within the first 4 hours) median increase of 44.5% in PaO₂/FiO₂. The mean (SD) starting dose was 30 (10) ng/kg/min. Medication errors were observed in 25% (4/16) of patients. Hypotension was the most frequently observed adverse event, with a rate of 18.8% (3/16).
  
  
  CONCLUSIONS
  Based on study findings, inhaled epoprostenol may improve oxygenation in patients with ARDS, with findings suggesting a 62.5% response to therapy. The significance of these effects on improving survival remains unknown. The frequency of medication errors observed in this study poses a significant concern regarding the administration of epoprostenol. Further controlled prospective studies are needed to determine the role of inhaled epoprostenol in improving survival in patients with ARDS.
authors: Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA. kadunkley@yahoo.com
authors: Kisha A
authors: KA
authors: Dunkley
authors: Patricia R
authors: PR
authors: Louzon
authors: Jinjoo
authors: J
authors: Lee
authors: Steve
authors: S
authors: Vu
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008508:Medication Errors / Q000639:trends; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D016019:Survival Analysis