The Use of Inhaled Prostaglandins in Patients With ARDS

Fuller, Brian M.; Mohr, Nicholas M.; Skrupky, Lee P.; Fowler, Susan A.; Kollef, Marin H.; Carpenter, Christopher R.

doi:10.1378/chest.14-3161

Cited by 115 publications

(136 citation statements)

References 62 publications

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“…PG is one of them but its role in ARDS is not clear. [12][13][14][15] In the present study also, inhibition of PG synthesis by indomethacin pretreatment killed the animals within 15 min of OA administration as reported earlier indicating a beneficial role of PG in ARDS. Further, improvement in the RF, HR, MAP, and lung injury when PGE1 analog (misoprostol) was given as pretreatment along with indomethacin, indicates that PGs play a protective role in ARDS.…”

Section: Discussionsupporting

confidence: 87%

Protective role of prostaglandin E1 analog in indomethacin-induced deterioration in acute respiratory distress syndrome in rats

Sharma¹,

Pandey²,

Deshpande³

2017

Natl J Physiol Pharm Pharmacol

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Background: Acute respiratory distress syndrome (ARDS) is a severe inflammatory condition. Our earlier studies have characterized oleic acid (OA)-induced rat model of ARDS which was exacerbated by indomethacin (prostaglandin [PG] synthesis inhibitor). Aim and Objectives: The role of PGs in ARDS is ill defined as the results of earlier studies are conflicting. This study was undertaken to determine the effect of PGE1 analog (misoprostol) in indomethacin-induced exacerbation of ARDS in rats. Materials and Methods: The rats were anesthetized with urethane. Tracheal and jugular vein cannulation was done to keep the respiratory tract patent and deliver drugs, respectively. Respiratory excursions were recorded with the help of force displacement transducer. Cannulated carotid artery was connected to pressure transducer for recording of blood pressure. Electrocardiographic potentials were recorded by needle electrodes. Animals were divided into four groups. In Group I, OA (75 µl) was used to induce ARDS in rats. In Group II, OA was injected in indomethacinpretreated rats. In Group III (control group), animals were treated with ethanol. In Group IV, OA was administered after indomethacin + misoprostol pretreatment. Misoprostol treatment was repeated after OA injection at 20 min interval. Cardiorespiratory parameters (respiratory frequency, heart rate, mean arterial pressure, and pulmonary water content) were determined, and histological examination of the lung was done in all groups. Results: Indomethacin pretreatment drastically advanced the OA-induced ARDS. Misoprostol protected against the deterioration as indicated by improvement in all the parameters and increase in survival time. Conclusion: Results of this study indicate that PGs have protective role in ARDS.

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Section: Discussionsupporting

confidence: 87%

Protective role of prostaglandin E1 analog in indomethacin-induced deterioration in acute respiratory distress syndrome in rats

Sharma¹,

Pandey²,

Deshpande³

2017

Natl J Physiol Pharm Pharmacol

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“…Another meta-analysis of 25 studies showed that inhaled prostacyclin improved oxygenation and decreased pulmonary artery pressures but may be associated with harm by producing hypotension. 7 ECMO is a technique that dissociates mechanical ventilation and gas exchange, thereby reducing ventilator-associated lung injury. Multiple studies have evaluated the effect of ECMO on mortality in subjects with severe acute respiratory failure.…”

Section: See the Original Study On Page 127mentioning

confidence: 99%

Rescue Strategies in Severe Refractory Hypoxemic Respiratory Failure: Taking a Step Back

Vasudevan

2016

Respir Care

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“…Compared with iNO, inhaled prostanoids require no special application and monitoring equipment, and are therefore easier and less expensive to administer. This could be the reason for the increase in use over time in the treatment of ARDS [33], although there is no clinical data showing a mortality benefit and large scale randomized clinical trials (RCTs) are lacking [34]. In a meta-analysis in 2015, Fuller et al [34] demonstrate that inhaled prostaglandins improve oxygenation and decrease pulmonary artery pressures.…”

Section: Introductionmentioning

confidence: 99%

“…This could be the reason for the increase in use over time in the treatment of ARDS [33], although there is no clinical data showing a mortality benefit and large scale randomized clinical trials (RCTs) are lacking [34]. In a meta-analysis in 2015, Fuller et al [34] demonstrate that inhaled prostaglandins improve oxygenation and decrease pulmonary artery pressures. On the other hand, they also lower systemic pressure, with hypotension occurring in 17.4% of patients in observational studies [34].…”

Section: Introductionmentioning

confidence: 99%

Acute respiratory distress syndrome following cardiovascular surgery

Hoegl

Zwißler²,

Eltzschig

et al. 2016

Current Opinion in Anaesthesiology

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Purpose of review This review gives an update on current treatment options and novel concepts on the prevention and treatment of the acute respiratory distress syndrome (ARDS) in cardiovascular surgery patients. Recent findings The only proven beneficial therapeutic options in ARDS are those that help to prevent further ventilator-induced lung injury, such as prone position, use of lung-protective ventilation strategies, and extracorporeal membrane oxygenation. In the future also new approaches like mesenchymal cell therapy, activation of hypoxia-elicited transcription factors or targeting of purinergic signaling may be successful outside the experimental setting. Owing to the so far limited treatment options, it is of great importance to determine patients at risk for developing ARDS already perioperatively. In this context, serum biomarkers and lung injury prediction scores could be useful. Summary Preventing ARDS as a severe complication in the cardiovascular surgery setting may help to reduce morbidity and mortality. As cardiovascular surgery patients are of greater risk to develop ARDS, preventive interventions should be implemented early on. Especially, use of low tidal volumes, avoiding of fluid overload and restrictive blood transfusion regimes may help to prevent ARDS.

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The Use of Inhaled Prostaglandins in Patients With ARDS

Abstract: In ARDS, inhaled prostaglandins improve oxygenation and decrease pulmonary artery pressures and may be associated with harm. Data are limited both in terms of methodologic quality and demonstration of clinical benefit. The use of inhaled prostaglandins in ARDS needs further study.

Cited by 115 publications

References 62 publications

Protective role of prostaglandin E1 analog in indomethacin-induced deterioration in acute respiratory distress syndrome in rats

Protective role of prostaglandin E1 analog in indomethacin-induced deterioration in acute respiratory distress syndrome in rats

Rescue Strategies in Severe Refractory Hypoxemic Respiratory Failure: Taking a Step Back

Acute respiratory distress syndrome following cardiovascular surgery

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