Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA.
Ann Pharmacother. 2013 Jun;47(6):790-6. doi: 10.1345/aph.1R540. Epub 2013 May 8.
Acute respiratory distress syndrome (ARDS) is a type of hypoxic respiratory failure that results from ventilation and perfusion mismatching. Inhaled epoprostenol induces relaxation of smooth muscle in pulmonary vasculature, leading to improved oxygenation.
To determine if the use of inhaled epoprostenol produced a 10% or greater increase in the ratio of arterial partial pressure of oxygen (PaO₂) to fraction of inspired oxygen (FiO₂) in ARDS patients and to review adverse events and medication errors.
An observational chart review was performed based on a report generated from the electronic medical record system. Patients who received at least 1 dose of inhaled epoprostenol from January 1, 2008, to December 31, 2010, at any hospital within the Florida Hospital Health System were considered for inclusion. Demographics, dose, duration of therapy, adverse effects, medication errors, and outcomes data were collected.
Sixteen patients were included in the study. Oxygenation improved by 10% or more in 62.5% (10/16) of the patients, with an initial (within the first 4 hours) median increase of 44.5% in PaO₂/FiO₂. The mean (SD) starting dose was 30 (10) ng/kg/min. Medication errors were observed in 25% (4/16) of patients. Hypotension was the most frequently observed adverse event, with a rate of 18.8% (3/16).
Based on study findings, inhaled epoprostenol may improve oxygenation in patients with ARDS, with findings suggesting a 62.5% response to therapy. The significance of these effects on improving survival remains unknown. The frequency of medication errors observed in this study poses a significant concern regarding the administration of epoprostenol. Further controlled prospective studies are needed to determine the role of inhaled epoprostenol in improving survival in patients with ARDS.
急性呼吸窘迫综合征（ARDS）是一种由通气和灌注不匹配引起的低氧性呼吸衰竭。吸入依前列醇可使肺血管平滑肌松弛，从而改善氧合。
确定吸入依前列醇是否使 ARDS 患者的动脉血氧分压（PaO₂）与吸入氧分数（FiO₂）比值增加 10%或更多，并回顾不良事件和用药错误。
根据电子病历系统生成的报告进行观察性图表回顾。考虑纳入在佛罗里达医院卫生系统内的任何医院于 2008 年 1 月 1 日至 2010 年 12 月 31 日期间至少接受 1 次吸入依前列醇治疗的患者。收集患者的人口统计学数据、剂量、治疗持续时间、不良反应、用药错误和结局数据。
研究纳入 16 例患者。62.5%（10/16）的患者氧合改善 10%或更多，初始（4 小时内）PaO₂/FiO₂中位数增加 44.5%。平均（SD）起始剂量为 30（10）ng/kg/min。25%（4/16）的患者发生用药错误。低血压是最常见的不良反应，发生率为 18.8%（3/16）。
根据研究结果，吸入依前列醇可能改善 ARDS 患者的氧合，研究结果提示治疗反应率为 62.5%。这些治疗效果对提高生存率的意义尚不清楚。本研究中观察到的用药错误频率对依前列醇的给药提出了重大关注。需要进一步的对照前瞻性研究来确定吸入依前列醇在改善 ARDS 患者生存率中的作用。
