Efficacy, Safety, and Medication Errors Associated with the Use of Inhaled Epoprostenol for Adults with Acute Respiratory Distress Syndrome: A Pilot Study

Dunkley, Kisha A; Louzon, Patricia; Lee, Jinjoo; Vu, S. Le

doi:10.1345/aph.1r540

Cited by 33 publications

(57 citation statements)

References 24 publications

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“…43 Furthermore, some of the cohort studies specifi cally excluded patients whose oxygenation did not respond to therapy, and although averaged measures of oxygenation were found to improve for the group overall, multiple studies report that a signifi cant percentage of patients were nonresponders. [34][35][36]39,44 So, it is possible that inhaled prostaglandins confer no oxygenation benefi t, and these results refl ect improved oxygenation secondary to a change in F io 2 or other concomitant therapies that were not reported (eg, prone positioning, positive end-expiratory pressure setting).…”

Section: Discussionmentioning

confidence: 99%

The Use of Inhaled Prostaglandins in Patients With ARDS

Fuller

Mohr

Skrupky

et al. 2015

Chest

115

124

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Section: Discussionmentioning

confidence: 99%

The Use of Inhaled Prostaglandins in Patients With ARDS

Fuller

Mohr

Skrupky

et al. 2015

Chest

115

124

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“…However, observational studies and case series have shown efficacy of inhaled prostaglandins for improved oxygenation in severe hypoxemia due to ARDS. A recent retrospective chart review, which included 16 patients treated with inhaled epoprostenol, showed that epoprostenol improved oxygenation (defined as an improvement in P aO2 /F IO2 of >10% from the baseline) in 62.5% of the treated patients [19, 20]. Therefore, inhaled prostaglandins have been increasingly used lately as a rescue therapy for severe refractory hypoxemia in severe ARDS given its cost effectiveness compared to inhaled nitric oxide as well as similar efficacy for improving oxygenation and safety outcomes [21].…”

Section: Discussionmentioning

confidence: 99%

Zinc Chloride Smoke Inhalation Induced Severe Acute Respiratory Distress Syndrome: First Survival in the United States with Extended Duration (Five Weeks) Therapy with High Dose Corticosteroids in Combination with Lung Protective Ventilation

Mahboob

Richeson

McCain

2017

Case Reports in Critical Care

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Zinc chloride smoke bomb exposure is frequently seen in military drills, combat exercises, metal industry works, and disaster simulations. Smoke exposure presents with variety of pulmonary damage based on the intensity of the exposure. Smoke induced severe acute respiratory distress syndrome (ARDS) is often fatal and there are no standard treatment guidelines. We report the first survival of smoke induced severe ARDS in the United States (US) with prolonged use of high dose steroids (five weeks) and lung protective ventilation alone. Previously reported surviving patients in China and Taiwan required extracorporeal membrane oxygenation (ECMO) and other invasive modalities. We suggest that an extended course of high dose corticosteroids should be considered for the treatment of smoke inhalation related ARDS and should be introduced as early as possible to minimize the morbidity and mortality. We further suggest that patients with smoke inhalation should be observed in the hospital for at least 48 to 72 hours before discharge, as ARDS can have a delayed onset. Being vigilant for infectious complications is important due to prolonged steroid treatment regimen. Patients must also be monitored for critical illness polyneuromyopathy. Additionally, upper airway injury should be suspected and early evaluation by otorhinolaryngology may be beneficial.

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“…This strategy is advantageous as it facilitates more‐rapid dose titration and does not require preparation of multiple dilutions of epoprostenol. However, a weight‐based approach necessitates multiple dosing calculations, in which errors have been reported . As such, dosing charts have been developed and are recommended to guide calculations and minimize the risk of medication errors …”

Section: Dosing and Administration Of Inhaled Pulmonary Vasodilatorsmentioning

confidence: 99%

“…However, a weightbased approach necessitates multiple dosing calculations, in which errors have been reported. 50 As such, dosing charts have been developed and are recommended to guide calculations and minimize the risk of medication errors. 29 Previously, Flolan (reconstituted with glycine diluent) was the only epoprostenol product available.…”

Section: Inhaled Prostacyclin Analogsmentioning

confidence: 99%

Inhaled Pulmonary Vasodilator Therapy for Management of Right Ventricular Dysfunction after Left Ventricular Assist Device Placement and Cardiac Transplantation

et al. 2017

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Right ventricular failure (RVF) after cardiac transplant (CTX) or implantation of a continuous-flow left ventricular assist device (CF-LVAD) is associated with significant postoperative morbidity and mortality. A variety of modalities have been used to treat postoperative RVF, including management of volume status, intravenous inotropes and vasodilators, and right-sided mechanical support. Inhaled vasodilator agents are a unique treatment option aimed at minimizing systemic absorption by delivering therapy directly to the pulmonary vasculature. Current LVAD and CTX guidelines endorse inhaled vasodilators for managing postoperative RVF; however, no guidance is offered regarding agent selection, dosing, or administration. A review of the current literature confirms that inhaled pulmonary vasodilator agents have been shown to decrease pulmonary artery pressure when used in the perioperative period of CF-LVAD implant or CTX. However, the literature regarding the potential impact on clinical outcomes (e.g., survival or risk of developing RVF) is lacking with these medications. Based on our assessment of the literature, we suggest that when RVF occurs in the setting of a normal pulmonary vascular resistance (PVR), traditional inotropic therapy (e.g., dobutamine) should be used. Conversely, if the PVR is elevated (> 250 dynes/sec/cm 5 or 3 Wood units), or the patient has other evidence of a high right ventricular afterload (i.e., a transpulmonary gradient > 12 mm Hg), then an inhaled pulmonary vasodilator would be the preferred initial pharmacologic agent. Drug selection depends largely on the institution's capacity to safely prepare and administer the medication, along with formulary considerations, such as the high costs associated with inhaled iloprost and inhaled nitric oxide. KEY WORDS heart transplantation, left ventricular assist device, right heart failure, pulmonary arterial hypertension, inhaled pulmonary vasodilators. (Pharmacotherapy 2017;37(8):944-955)

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Efficacy, Safety, and Medication Errors Associated with the Use of Inhaled Epoprostenol for Adults with Acute Respiratory Distress Syndrome: A Pilot Study

Cited by 33 publications

References 24 publications

The Use of Inhaled Prostaglandins in Patients With ARDS

The Use of Inhaled Prostaglandins in Patients With ARDS

Zinc Chloride Smoke Inhalation Induced Severe Acute Respiratory Distress Syndrome: First Survival in the United States with Extended Duration (Five Weeks) Therapy with High Dose Corticosteroids in Combination with Lung Protective Ventilation

Inhaled Pulmonary Vasodilator Therapy for Management of Right Ventricular Dysfunction after Left Ventricular Assist Device Placement and Cardiac Transplantation

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