Epoprostenol Via High-Flow Nasal Cannula Improves Severe Hypoxemia in PH

For patients with severe hypoxemia with pulmonary hypertension or right heart dysfunction, inhaled epoprostenol through high-flow nasal cannula increases oxygenation, according to a study published in Pharmaceutics.

The researchers of this retrospective study assessed the effect of inhaled epoprostenol using a high-flow nasal cannula on oxygenation and future mechanical ventilation in patients with hypoxemia comorbid with pulmonary hypertension or right heart dysfunction in an intensive care unit setting.

A chart review was completed on adult patients who were admitted into the respiratory care department of the Rush University Medical Center for severe hypoxemia between July 2015 and April 2018 and treated with inhaled epoprostenol through the high-flow nasal cannula. Demographic information, intake Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II scores, and clinical measurements were retrieved from patients’ charts.

Of the 11 individuals included, 4 were men, 5 were white, the mean age was 57.5 years old, the mean APACHE II score was 18.5, 10 patients had chronic heart or lung comorbidities, and 7 patients used home oxygen. One patient did not respond to the inhaled epoprostenol.

Overall, the inhaled epoprostenol increased the average peripheral capillary oxygen saturation (SpO2)/fraction of inspired oxygen ratio from 107.5 to 125.5 (P =.026) in 30 to 60 minutes, and responders (n=5) significantly improved SpO2 from 87.6% to 96.6% (P =.03).

There were no differences found among heart rate, blood pressure, and respiratory rate before and after inhaled epoprostenol. Outcomes included 7 patients not requiring intubation and 7 patients who were discharged.

Limitations of this study include its retrospective nature, the lack of a control group, the small sample size, and using SpO2/fraction of inspired oxygen ratio to evaluate oxygenation, rather than the partial pressure of oxygen/fraction of inspired oxygen ratio.

The researchers concluded that “[t]his retrospective study demonstrated the feasibility of inhaled epoprostenol via [high-flow nasal cannula] in improving oxygenation in adult subjects with severe hypoxemia with pulmonary hypertension or right heart dysfunction.”

Reference

Li J, Harnois LJ, Markos B, et al. Epoprostenol delivered via high flow nasal cannula for ICU subjects with severe hypoxemia comorbid with pulmonary hypertension or right heart dysfunction.Pharmaceutics. 2019;11(6):281.