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Cyrene Molineros, PharmD
Critical Care Clinical Pharmacist Specialist
AdventHealth Critical Care at Central Florida
Daytona Beach, Florida
Disclosure information not submitted.
Patricia Louzon, BCCCP, PharmD, FCCM
AdventHealth Orlando
Orlando, Florida
Disclosure information not submitted.
Davide Ventura, PharmD, BCCCP
Clinical Pharmacist Specialist - Cardiology
AdventHealth, United States
Disclosure information not submitted.
Christopher Ensor, PharmD, BCPS, FAST, FCCP
Clinical Manager for Academic Affairs
AdventHealth, United States
Disclosure information not submitted.
Scott Silvestri, MD
Cardiac Surgery, Cardiovascular and Thoracic Surgery
AdventHealth, United States
Disclosure information not submitted.
Nicholas Cavarocchi, MD
Critical Care Medicine
AdventHealth, United States
Disclosure information not submitted.
Brittany DeOliveira, PharmD
Clinical Pharmacist
AdventHealth Critical Care at Central Florida
Orlando, Florida, United States
Disclosure information not submitted.
Title: Nebulized Treprostinil in Pulmonary Hypertension or Acute Respiratory Distress Syndrome
Introduction: Inhaled treprostinil has a longer half-life and potential for easier administration than inhaled epoprostenol (iEPO) but has not been routinely utilized in mechanically ventilated patients due to its design for use with a specific inhalation system. The goal of this study was to compare the relative efficacy and safety of a dosing protocol of inhaled treprostinil versus iEPO therapy administered via vibrating mesh nebulizer in mechanically ventilated and non-ventilated patients with acute pulmonary hypertension (PH) following cardiovascular (CV) surgery and in acute respiratory distress syndrome (ARDS).
Methods: A dosing protocol for inhaled treprostinil via nebulizer in mechanically ventilated patients was developed from a prior in vitro study. ICU patients utilizing the inhaled treprostinil dosing protocol for acute PH or ARDS were retrospectively matched 1:1 to iEPO treated patients based on APACHE II score, age, and diagnosis or type of CV surgery. Data was retrospectively reviewed and compared for baseline characteristics, hemodynamics, oxygenation endpoints and adverse events.
Results: 34 patients were included in the acute PH post-CV surgery group and 84 in the ARDS group. Baseline characteristics were similar between therapies in both groups. Most patients included in the ARDS group were classified as severe ARDS. In the CV group, the primary endpoint of maintaining or decreasing mPAP by 10% after 6 hours and 24 hours post-inhaled prostacyclin therapy was similar between treprostinil and iEPO (p=0.47 and p=0.57, respectively). For the ARDS group, the primary outcome of maintaining or increasing PaO2/FiO2 by 10% after 6 hours and 24 hours was achieved in more patients utilizing iEPO than inhaled treprostinil (p=0.02 and p=0.003, respectively). No bleeding events were noted with either medication. Medication cost of inhaled treprostinil therapy was higher in comparison to iEPO (p< 0.001).
Conclusions: Inhaled treprostinil administration via vibrating mesh nebulizer is feasible to operationalize and compared to iEPO may be an option to reduce mPAP in post-CV surgical patients with acute PH but may not be equivalent in improving oxygenation in ARDS. Use of inhaled treprostinil for these indications requires further study.