title: Inhaled epoprostenol vs inhaled nitric oxide for refractory hypoxemia in critically ill patients.
abstract: OBJECTIVE
  The purpose of this is to compare efficacy, safety, and cost outcomes in patients who have received either inhaled epoprostenol (iEPO) or inhaled nitric oxide (iNO) for hypoxic respiratory failure.
  
  
  METHODS
  This is a retrospective, single-center analysis of adult, mechanically ventilated patients receiving iNO or iEPO for improvement in oxygenation.
  
  
  RESULTS
  We evaluated 105 mechanically ventilated patients who received iEPO (52 patients) or iNO (53 patients) between January 2009 and October 2010. Most patients received therapy for acute respiratory distress syndrome (iNO 58.5% vs iEPO 61.5%; P=.84). There was no difference in the change in the partial pressure of arterial O2/fraction of inspired O2 ratio after 1 hour of therapy (20.58±91.54 vs 33.04±36.19 [P=.36]) in the iNO and iEPO groups, respectively. No difference was observed in duration of therapy (P=.63), mechanical ventilation (P=.07), intensive care unit (P=.67), and hospital lengths of stay (P=.26) comparing the iNO and iEPO groups. No adverse events were attributed to either therapy. Inhaled nitric oxide was 4.5 to 17 times more expensive than iEPO depending on contract pricing.
  
  
  CONCLUSIONS
  We found no difference in efficacy and safety outcomes when comparing iNO and iEPO in hypoxic, critically ill patients. Inhaled epoprostenol is associated with less drug expenditure than iNO.
authors.affiliation: Department of Pharmacy, Brigham and Women's Hospital, Boston, MA 02115. Electronic address: htorbic@partners.org.
authors.forename: Heather
authors.initials: H
authors.lastname: Torbic
authors.forename: Paul M
authors.initials: PM
authors.lastname: Szumita
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Anger
authors.forename: Paul
authors.initials: P
authors.lastname: Nuccio
authors.forename: Susan
authors.initials: S
authors.lastname: LaGambina
authors.forename: Gerald
authors.initials: G
authors.lastname: Weinhouse
mesh_terms: D018806:APACHE; D000280:Administration, Inhalation; D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000191:economics; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000191:economics; D015897:Comorbidity; D016638:Critical Illness; D011464:Epoprostenol / Q000008:administration & dosage* / Q000191:economics; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage* / Q000191:economics; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D001993:Bronchodilator Agents; D009569:Nitric Oxide; D011464:Epoprostenol
keywords: ARDS; Epoprostenol; Hypoxemia; Nitric oxide; Pulmonary vasodilator