Mitchell Buckley, BCCCP, PharmD, FCCP
Clinical Pharmacy Specialist
Banner University Medical Center Phoenix
Phoenix, Arizona
Disclosure information not submitted.
Angel Mendez, PharmD
Clinical Pharmacist
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona, United States
Disclosure information not submitted.
John Radosevich, BCCCP, BCPS, PharmD
Clinical Pharmacist
Saint Josephs Hospital and Medical Center, United States
Disclosure information not submitted.
Sumit Agarwal, MBBS, MBA
Assistant Professor
University of Arizona, United States
Disclosure information not submitted.
Robert MacLaren, Pharm.D., MPH, FCCM, FCCP
Professor
University of Colorado, United States
Disclosure information not submitted.
Title: Comparison of Weight-Based vs. Fixed-Dose Inhaled Epoprostenol in Critically Ill ARDS Patients
Introduction/Hypothesis: Inhaled epoprostenol (iEPO) has been shown to improve oxygenation in moderate-to-severe acute respiratory distress syndrome (ARDS) despite its role in therapy remaining controversial. However, a direct comparison between two different iEPO dosing approaches is lacking. Therefore, the purpose of this study was to evaluate the impact on oxygenation parameters between fixed and weight-based iEPO dosing strategies in ARDS adult patients.
Methods: This was a multicenter, retrospective cohort study conducted at two academic medical centers between January 1, 2016 and August 30, 2020. Patients ≥18 years with moderate-to-severe ARDS (PaO2/FiO2 < 150 mmHg) administered iEPO were categorized into two study groups (weight-based or fixed-dose). The primary endpoint was to compare the highest mean change in PaO2/FiO2 up to four hours from baseline between study groups. Other secondary aims were the iEPO response (increase of PaO2/FiO2 ≥10% within 4 hours from baseline) rates, in-hospital mortality, hospital length of stay, and duration of mechanical ventilation.
Results: A total of 294 patients were included with 194 (66.0%) and 100 (34.0%) in the iEPO fixed-dose and weight-based dose groups, respectively. The mean highest PaO2:FiO2 change recorded from baseline up to 4 hours after initiation in the iEPO fixed-dose and weight-based dose groups were 81.1 ± 106.0 and 41.0 ± 72.5 mmHg, respectively (p=0.0015). No significant differences in the mean PaO2:FiO2 between study groups were found within 12 hours after iEPO administration except within the first hour which showed a higher PaO2:FiO2 associated with the fixed-dose regimen. Univariate analysis between responders and nonresponders at 4 hours after iEPO initiation found a significantly higher response rate in the fixed-dose group (69.9%) compared to the weight-based dose group (30.1%) (p=0.02). Clinical outcomes including mortality, hospital length of stay, mechanical ventilation duration and mechanical ventilation-free days were not significantly different between study groups.
Conclusions: A fixed-dose iEPO strategy for patients with moderate-to-severe ARDS was comparable to weight-based approach. These findings support the use of fixed-dose iEPO in ARDS as a simplified and convenient alternative to weight-based dosing.