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Comparison between prostaglandin E1 and epoprostenol (prostacyclin) in infants after heart surgery
1Intensive Care Unit, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Prostaglandin E1 and epoprostenol effectively reduced pulmonary hypertension in infants. A lower dose of epoprostenol (5 ng/kg/min) showed similar results to a higher dose of prostaglandin E1 (30 ng/kg/min).
Area of Science:
- Pediatric Cardiology
- Neonatology
- Pharmacology
Background:
- Infants with pulmonary hypertension often require advanced cardiovascular support.
- Prostaglandin E1 and epoprostenol are vasodilators used in managing pulmonary hypertension.
- Direct comparison of their dose-response and effectiveness in this population is crucial.
Purpose of the Study:
- To determine the dose-response characteristics of prostaglandin E1 and epoprostenol.
- To directly compare the efficacy of these two agents as pulmonary vasodilators in infants with pulmonary hypertension.
Main Methods:
- A randomized crossover design was employed in 20 infants post-cardiac surgery with pulmonary hypertension.
- Hemodynamic parameters, including cardiac output (measured by Doppler ultrasound), were assessed at varying doses (prostaglandin E1: 10, 30, 100 ng/kg/min; epoprostenol: 5, 10, 25 ng/kg/min).
- Pulmonary and systemic vascular resistances were calculated and compared.
Main Results:
- Both prostaglandin E1 and epoprostenol demonstrated significant pulmonary vasodilator effects.
- An epoprostenol dose of 5 ng/kg/min was found to be equivalent in efficacy to a prostaglandin E1 dose of 30 ng/kg/min.
- The study did not find evidence of pulmonary specificity for either vasodilator.
Conclusions:
- Prostaglandin E1 and epoprostenol are effective pulmonary vasodilators in infants with pulmonary hypertension.
- Epoprostenol may be a more potent vasodilator than prostaglandin E1 on a weight-based dose comparison.
- Neither agent exhibited specific action on the pulmonary vasculature over the systemic circulation.
Objective:
To study the dose response characteristics of prostaglandin E1 and epoprostenol (prostacyclin) and directly to compare their effectiveness as pulmonary vasodilators in infants with pulmonary hypertension.
Design:
A crossover design with each patient receiving both drugs in random order.
Setting:
Infants were studied in the intensive care unit while they were sedated, paralysed, and ventilated.
Patients:
Twenty infants who had undergone corrective cardiac surgery and who were in sinus rhythm, had stable haemodynamic function, and had a pulmonary artery catheter in place. All infants were receiving dopamine and phenoxybenzamine.
Interventions:
Baseline haemodynamic measurements were taken and an infusion of the first drug was started at the lowest dose: after 20 minutes the measurements were repeated and the dose increased. This protocol was repeated for all doses of both drugs: 10, 30, and 100 ng/kg/min of prostaglandin E1 and 5, 10, and 25 ng/kg/min of epoprostenol. Cardiac output was measured by the pulsed Doppler ultrasound method.
Main Outcome Measures:
Pulmonary and systemic vascular resistances were calculated from the cardiac output and compared by the Wilcoxon signed ranks test.
Results:
Both prostaglandin E1 and epoprostenol were effective vasodilators: 5 ng/kg/min of epoprostenol was equivalent to 30 ng/kg/min of prostaglandin E1.
Conclusions:
Neither drug showed pulmonary specificity.