title: Clinical and Economic Impact of Formulary Conversion From Inhaled Flolan to Inhaled Veletri for Refractory Hypoxemia in Critically Ill Patients.
abstract: BACKGROUND
  Flolan (iFLO) and Veletri (iVEL) are 2 inhaled epoprostenol formulations. There is no published literature comparing these formulations in critically ill patients with refractory hypoxemia.
  
  
  OBJECTIVE
  To compare efficacy, safety, and cost outcomes in patients who received either iFLO or iVEL for hypoxic respiratory failure.
  
  
  METHODS
  This was a retrospective, single-center analysis of adult, mechanically ventilated patients receiving iFLO or iVEL for improvement in oxygenation. The primary end point was the change in the PaO2/FiO2 ratio after 1 hour of pulmonary vasodilator therapy. Secondary end points assessed were intensive care unit (ICU) length of stay (LOS), hospital LOS, duration of study therapy, duration of mechanical ventilation, mortality, incidence of adverse events, and cost.
  
  
  RESULTS
  A total of 104 patients were included (iFLO = 52; iVEL = 52). More iFLO patients had acute respiratory distress syndrome compared with the iVEL group (61.5 vs 34.6%; P = 0.01). There was no difference in the change in the PaO2/FiO2 ratio after 1 hour of therapy (33.04 ± 36.9 vs 31.47 ± 19.92; P = 0.54) in the iFLO and iVEL groups, respectively. Patients who received iVEL had a shorter duration of mechanical ventilation (P < 0.001) and ICU LOS (P < 0.001) but not hospital LOS (P = 0.86) and duration of therapy (P = 0.36). No adverse events were attributed to pulmonary vasodilator therapy, and there was no difference in cost.
  
  
  CONCLUSIONS
  We found no difference between iFLO and iVEL when comparing the change in the PaO2/FiO2 ratio, safety, and cost in hypoxic, critically ill patients. There were differences in secondary outcomes, likely a result of differences in underlying indication for inhaled epoprostenol.
authors.affiliation: Cleveland Clinic, Cleveland, OH, USA torbich@ccf.org.
authors.forename: Heather
authors.initials: H
authors.lastname: Torbic
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Szumita
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Anger
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Nuccio
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Lagambina
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Weinhouse
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D016638:Critical Illness; D011464:Epoprostenol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000188:drug therapy*; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011725:Pyridines / Q000008:administration & dosage*; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000188:drug therapy; D012131:Respiratory Insufficiency / Q000188:drug therapy*; D012189:Retrospective Studies; D013777:Tetrazoles / Q000008:administration & dosage*; D013997:Time Factors; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D011725:Pyridines; D013777:Tetrazoles; D014665:Vasodilator Agents; C120582:tezosentan; D011464:Epoprostenol
keywords: critical care; pharmacoeconomics; prostaglandins; respiratory failure; vasodilators