1 Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT, USA.
2 Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
Ann Pharmacother. 2018 Dec;52(12):1173-1181. doi: 10.1177/1060028018782209. Epub 2018 Jun 12.
The administration of inhaled epoprostenol (iEPO) through noninvasive routes of ventilator support systems has never been previously evaluated.
Describe the use of iEPO when administered through noninvasive routes of ventilator support systems.
Critically ill patients admitted to the intensive care unit who received iEPO through noninvasive routes were analyzed. Improvements in respiratory status and hemodynamic parameters were evaluated. Safety end points assessed included hypotension, rebound hypoxemia, significant bleeding, and thrombocytopenia.
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.
通过无创通气支持系统的途径给予吸入性依前列醇（iEPO）的应用尚未被评估过。
描述通过无创通气支持系统途径给予 iEPO 的应用。
对在重症监护病房接受 iEPO 治疗的患者进行了分析，这些患者通过无创途径给予了 iEPO。评估了呼吸状态和血流动力学参数的改善情况。评估的安全性终点包括低血压、低氧血症反弹、显著出血和血小板减少症。
共有 36 名患者通过无创途径接受了 iEPO：经鼻导管高流量氧疗，n = 29（81%）和无创正压通气，n = 7（19%）。16 名患者的呼吸状态得到改善：吸入氧分数（FiO）平均降低 20%±13%；动脉氧分压与 FiO 的比值（PaO/FiO）平均升高 60±50mmHg；HFNC 氧气流量平均降低 6±3LPM。8 名患者的呼吸状态下降（FiO 平均升高 30%±20%；PaO/FiO 比值平均降低 38±20mmHg；HFNC 氧气流量平均增加 15±10LPM），12 名患者的呼吸状态没有变化。结论和相关性：这是首次评估通过无创通气支持系统途径给予 iEPO 的应用，结果表明在重症患者中，iEPO 可以通过无创途径给予。需要进一步评估这种给药途径的获益程度。
