Nicolas Tran, BCPS, PharmD
PGY-2 Critical Care Pharmacy Resident
Tampa General Hospital
Tampa, Florida
Disclosure information not submitted.
Kevin Ferguson, PharmD, BCPS, BCCCP
Critical Care Pharmacist
Tampa General Hospital, United States
Disclosure information not submitted.
Zachary Stachura, MD
Pulmonary Critical Care Physician
University of South Florida, United States
Disclosure information not submitted.
Chakrapol Sriaroon, MD
Pulmonary Critical Care Physician
University of South Florida, United States
Disclosure information not submitted.
Title: Evaluation of outcomes with inhaled epoprostenol (iEPO) in non-intubated ICU patients with COVID-19
Introduction: Coronavirus disease 2019 (COVID-19) emerged in 2019 causing a global pandemic. ICU patients often fit criteria for acute respiratory distress syndrome (ARDS). Therefore, their management is extrapolated from ARDS strategies including proning, lung-protective ventilator strategies, neuromuscular blockade, and other therapies such as iEPO. Our institution utilizes iEPO in non-intubated COVID-19 ICU patients through a closed-circuit aerosolized system. The goal of our study is to evaluate if the initiation of iEPO prevented intubation in non-intubated ICU patients with COVID-19.
Methods: A single-centered, IRB-exempt, retrospective chart review was performed on non-intubated adult ICU patients with COVID-19 who were administered iEPO between March 2020 to February 2021. Demographics, O2 requirements, blood gases pre-post iEPO initiation, and O2 saturations were collected. Our primary outcome was the percentage of patients who required intubation post iEPO initiation.
Results: Of 151 patients, 98 were included in our analysis. 53 patients were excluded due to intubation prior to the post-iEPO initiation blood gas or missing data. Most patients were Caucasian males with an average 7-day presentation from symptom onset. 95% of patients were on heated high-flow nasal cannula with a minimum of 40 liters of O2 at 40% of FiO2 or more prior to iEPO initiation. A total of 62 patients (63.3%) required intubation post iEPO initiation. The median time to intubation after iEPO initiation was 18.8 hours. In patients with an arterial blood gas within 24 hours of iEPO initiation, there was no significant improvement in PaO2:FiO2 ratio after iEPO initiation (127.3 ± 68.8 vs 138.9 ± 134.7; p=0.521).
Conclusions: Initiation of iEPO in non-intubated ICU patients did not prevent intubation in 63.3% of patients. Also, there were no significant improvements in PaO2:FiO2 ratios in patients who received iEPO. This study adds to the questionable benefits of iEPO in ARDS patients due to COVID-19. The median time to intubation for patients who were initiated on iEPO was 18.8 hours. Further studies are needed to determine if iEPO improves outcomes in non-intubated patients and an appropriate duration for iEPO therapy.