title: Administration of Inhaled Pulmonary Vasodilators to the Mechanically Ventilated Neonatal Patient.
abstract: Pulmonary hypertension is a life-threatening condition that affects people of all ages that can occur as an idiopathic disorder at birth or as part of a variety of cardiovascular and infectious disorders. It is commonly treated with inhaled pulmonary vasodilators such as nitric oxide and less frequently using formulations and analogs of prostacyclin. To minimize systemic effects and preserve pulmonary vasodilation, vasodilators are often administered directly into the airway. Nitric oxide is the only USA Food and Drug Administration-approved inhaled pulmonary vasodilator that can be used during mechanical ventilation. Over the past two decades, interest has grown in the use of aerosolized prostacyclin and prostacyclin analogs for the treatment of pulmonary hypertension during mechanical ventilation. Clinicians who administer inhaled prostacyclin may not have a clear understanding of its risks because of the lack of data from large clinical trials examining safety and efficacy; moreover, its safe use remains poorly documented. The off-label use of drugs is legitimate, but prescribers must recognize the potential complications and liability in doing so. This manuscript aims to address potential problems related to the aerosol administration of pulmonary vasodilators in the mechanically ventilated neonatal patient.
authors.affiliation: Physiology and Biophysics, Virginia Commonwealth University School of Medicine, 1217 East Marshall Street, Hermes A. Kontos Medical Sciences Building Room 215, Richmond, VA, 23298, USA. mdavis35@vcu.edu.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Davis
authors.affiliation: Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Donn
authors.affiliation: Professor Emeritus, Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Ward
mesh_terms: D000280:Administration, Inhalation; D000336:Aerosols; D011464:Epoprostenol / Q000008:administration & dosage; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000503:physiopathology; D007231:Infant, Newborn; D008168:Lung / Q000503:physiopathology; D009569:Nitric Oxide / Q000008:administration & dosage; D056687:Off-Label Use; D012121:Respiration, Artificial; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D000336:Aerosols; D014665:Vasodilator Agents; D009569:Nitric Oxide; D011464:Epoprostenol