Inhaled Epoprostenol Through Noninvasive Routes of Ventilator Support Systems

Abstract

A total of 36 patients received iEPO through noninvasive routes: high-flow oxygen therapy through nasal cannula, n = 29 (81%) and noninvasive positive-pressure ventilation, n = 7 (19%). Sixteen patients had improvement in their respiratory status: mean decrease in fraction of inspired oxygen (FiO), 20% ± 13%; mean increase in partial pressure of arterial oxygen to FiO (PaO/FiO) ratio, 60 ± 50 mm Hg; and mean decrease in HFNC oxygen flow rate, 6 ± 3 liters per minute (LPM). Eight patients had declines in their respiratory status (mean increase in FiO, 30% ± 20%; mean decrease in PaO/FiO ratio, 38 ± 20 mm Hg; and mean increase in HFNC oxygen flow rate, 15 ± 10 LPM), and 12 patients had no change in their respiratory status. Conclusion and Relevance: This represents the first evaluation of the administration of iEPO through noninvasive routes of ventilator support systems and demonstrates that in critically ill patients, iEPO could be administered through a noninvasive route. Further evaluation is needed to determine the extent of benefit with this route of administration.

The Clinical Impact of Flow Titration on Epoprostenol Delivery via High Flow Nasal Cannula for ICU Patients with Pulmonary Hypertension or Right Ventricular Dysfunction: A Retrospective Cohort Comparison Study

“…In this study, however, we found a trend of higher response rate in the group with flow titration (63.6% vs. 38.5%) (Table 5). Similarly, Ammar et al reported a mPAP reduction of 4.9 ± 6.2 mmHg after iEPO via HFNC in 9 patients with pulmonary hypertension using constant flow [9], this finding is consistent with the constant flow group (4.2 ± 3.9 mmHg) but lower than the mPAP reduction in the flow titration group (9.3 ± 6.3 mmHg) in our study. Additionally, the percentage of responders who had mPAP reduction of greater than 20% was higher in the flow titration group (46.2% vs. 0, p = 0.046).…”

“…SpO 2 /F I O 2 was substituted for PaO 2 /F I O 2 to evaluate oxygenation [8,16] in cases where arterial blood gases before and after iEPO initiation were not available. A patient was also considered a responder to iEPO if SpO 2 /F I O 2 increased by > 20% for ≥ 5 min or PaO 2 /F I O 2 increased by > 20% within 60 min of iEPO initiation [8,9].…”

“…Due to its short half-life, iEPO is continuously delivered for extended periods of time (usually > 24 h), which becomes a challenge for spontaneous breathing patients, as conventional aerosol therapy via mouthpiece or mask for a long duration is uncomfortable and impossible to maintain [4]. Transnasal pulmonary delivery of iEPO via high-flow nasal cannula (HFNC) provides a feasible route, which has been shown to deliver sufficient dose to elicit a clinical response [8,9].…”

In vitro comparison between inspiration synchronized and continuous vibrating mesh nebulizer during trans-nasal aerosol delivery

“…In recent years, aerosol delivery via high-flow nasal cannula (HFNC) has become a popular measure to deliver aerosol therapy [1][2][3][4][5][6][7][8], particularly for patients who are using HFNC concurrently [1][2][3][4][5]. At regular flow setting, trans-nasal albuterol delivery for stable patients with chronic obstructive airway diseases has been shown to elicit similar response as conventional nebulization treatment [6][7][8], such as small volume jet nebulizer via mask/mouthpiece or metered dose inhaler with spacer.…”

“…Due to its features of no additional gas and little to no residual volume, vibrating mesh nebulizer (VMN) has been commonly utilized in trans-nasal aerosol delivery [1][2][3][4][5][7][8][9]. However, the currently available commercial product of VMN generates aerosol continuously.…”