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Aerosolized iloprost customized for the critically ill.

Keith W Harris1, Thomas G O'Riordan, Gerald C Smaldone

  • 1Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, State University of New York at Stony Brook, Stony Brook, NY 11794-8172, USA. kharris@notes.cc.sunysb.edu

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|November 1, 2007
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Summary

New aerosol delivery systems allow for effective delivery of iloprost to critically ill patients on mechanical ventilation or high-flow oxygen. This advances pulmonary hypertension treatment for unstable patients.

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Area of Science:

  • Pulmonary Medicine
  • Critical Care
  • Pharmacology

Background:

  • Aerosolized iloprost is approved for pulmonary hypertension but requires stable patients.
  • Current delivery methods are unsuitable for critically ill patients needing mechanical ventilation or high oxygen.
  • New delivery systems were developed for these patient populations.

Purpose of the Study:

  • To design and evaluate novel aerosol delivery systems for iloprost.
  • To achieve doses comparable to existing high-efficiency nebulizers.
  • To enable iloprost administration in mechanically ventilated and spontaneously breathing patients requiring high oxygen.

Main Methods:

  • Two systems were designed: one for intubated patients (AeroTech II jet nebulizer with breath-actuated ventilator circuit) and one for spontaneous breathing (Pulmanex Hi-Ox mask with AeroTech II nebulizer).
  • A 20 microg dose was used, and inhaled mass was measured using technetium-99m radiolabel.
  • Drug accuracy was verified with HPLC, and particle distribution was analyzed using a cascade impactor.

Main Results:

  • Radiolabel accurately represented iloprost concentration.
  • Mean inhaled mass was 6.02 +/- 0.87 microg (ventilator) and 3.77 +/- 0.46 microg (spontaneous breathing).
  • Particle distribution showed a mass median aerodynamic diameter of 0.7 microm and a fine-particle fraction of 0.99 for both systems.

Conclusions:

  • Clinically effective doses of aerosolized iloprost can be delivered to critically ill patients.
  • These systems provide a viable option for pulmonary hypertension treatment in patients requiring mechanical ventilation or high-flow oxygen.