Inhaled epoprostenol utilization pattern after implementation of an administration policy

Abstract

Epoprostenol, a pulmonary vasodilator, is used to reduce pulmonary artery pressure. Its inhaled administration results in ventilation and perfusion matching with oxygenation improvement. Epoprostenol is used as treatment for various conditions, particularly acute respiratory distress syndrome (ARDS) and pulmonary arterial hypertension. In 2018, Baylor University Medical Center implemented a policy for inhaled epoprostenol utilization aimed at standardizing clinical practice. This study analyzed epoprostenol utilization patterns in patients with ARDS after implementation of this administration policy. Drug responders and nonresponders were compared for clinical outcomes and physiologic changes before and after use, and policy compliance was evaluated. Of 79 eligible patients, 30 fulfilled inclusion criteria: 14 (47%) had ARDS and 16 (53%) had non-ARDS. In all patients with ARDS, epoprostenol was a second rescue agent after neuromuscular blockade, prone positioning, corticosteroids, and extracorporeal membrane oxygenation. Epoprostenol was associated with statistically significant improvement of oxygenation before and after utilization in patients with ARDS (ratio of arterial oxygen partial pressure to fractional inspired oxygen 70 vs 140, respectively; P ¼ 0.04). Overall, 10 (71%) ARDS patients were epoprostenol responders; 9 (56%) were deemed responders among subjects with non-ARDS. Comparison of outcomes between responders and nonresponders showed no statistically significant variations. Policy compliance was obtained in 24 (80%) patients.

A Narrative Review on the Administration of Inhaled Prostaglandins in Critically Ill Adult Patients With Acute Respiratory Distress Syndrome

“…36 Overall, 71% of the patients with ARDS responded to iEPO therapy with an increase in median P/F ratio from 70 to 140. 36…”

“…Collier et al reported thrombocytopenia occurring in 29% and 28% of ARDS and non-ARDS patients, respectively, and Fuller et al found 3 studies reported thrombocytopenia, anemia, or transfusion requirements. 22,36 In contrast, Van Heerden et al reported no effects on platelet aggregation. 50…”

“…36 Of the 14 ARDS patients included, 10 were classified as having severe ARDS per the Berlin criteria. 36 Patients were considered responders if their PaO 2 increased by at least 10%. 36 Overall, 71% of the patients with ARDS responded to iEPO therapy with an increase in median P/F ratio from 70 to 140.…”

“…36 Patients were considered responders if their PaO 2 increased by at least 10%. 36 Overall, 71% of the patients with ARDS responded to iEPO therapy with an increase in median P/F ratio from 70 to 140. 36…”

“…22 One analysis originating from a quality improvement project assessed the use of iEPO in both ARDS and non-ARDS patients. 36 Of the 14 ARDS patients included, 10 were classified as having severe ARDS per the Berlin criteria. 36 Patients were considered responders if their PaO 2 increased by at least 10%.…”