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Inhaled prostacyclin (PGI₂) is an effective addition to the treatment of pulmonary hypertension and hypoxia in the operating room and intensive care unit

[L'inhalation de prostacycline (PGI₂) est un traitement complémentaire efficace de l'hypertension pulmonaire et de l'hypoxie observées en salle d'opération et à l'unité des soins intensifs]

Manon Haché, MD^*, André Y. Denault, MD FRCPC^*, Sylvain Bélisle, MD FRCPC^*, Pierre Couture, MD FRCPC^*, Denis Babin, MSc^*, Francine Tétrault, pharm MSc and Jean-Gilles Guimond, MD FRCPC

^* From the Department of Anesthesiology, Montreal Heart Institute, and the
Departments Of Pharmacy, and
Medicine Centre Hospitalier de l'Université de Montréal (CHUM), Campus Notre-Dame, Montreal, Quebec, Canada.

Address correspondence to: Dr. A.Y. Denault, Department of Anesthesiology, Montreal Heart Institute, 5000 Belanger Street East, Montreal, Quebec H1T 1C8, Canada. Phone: 514-376-3330, ext. 3732; Fax: 514-376-8784; E-mail: denault{at}videotron.ca

Purpose: There is a growing interest in the intraoperative and intensive care use of inhaled epoprostenol (PGI₂) for the treatment of pulmonary hypertension (PHT) and hypoxia of cardiac or non-cardiac origin. We report our experience with this form of therapy.

Methods: A retrospective chart review of all patients who received inhaled PGI₂ over a one-year period was undertaken. Demographic, hemodynamic, oxygenation status, mode of administration, side effects, duration of hospital stay, and mortality were noted.

Results: Thirty-five patients, of which 33 (92%) were in the intensive care unit, received inhaled PGI₂. Of the 27 patients whose pulmonary artery pressure (PAP) was monitored, a significant decrease in mean PAP from 34.8 ± 11.8 mmHg to 32.1 ± 11.8 mmHg was observed within one hour after the start of therapy (P=0.0017). Selective pulmonary vasodilatation occurred in 77.8% of the patients. Thirty-three patients had arterial blood gases before and after therapy. There was an improvement in the PaO₂/FIO₂ ratio in 88% of these with a 175% improvement on average. The ratio of PaO₂/FIO₂ improved from 108 ± 8 to 138 ± 105 (P=0.001). Six patients (17%) presented hypotension, two had subsequent pneumothorax, one had bronchospasm and in one patient PGI₂ inhalation was stopped because of increasing peak pulmonary pressures from the secondary flow coming from the nebulizer. Mortality of the cohort was 54%.

Conclusion: Inhaled PGI₂ can be useful in the treatment of patients with PHT and severe hypoxia. It can however be associated with systemic side effects.

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