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Prostacyclin in the intensive care setting.

¹Department of Pediatrics, University of Colorado Denver School of Medicine, The Children's Hospital, Aurora, CO, USA. ivy.dunbar@tchden.org

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

|March 11, 2010

Summary

Inhaled prostanoids like epoprostenol, treprostinil, and iloprost are increasingly used for pulmonary arterial hypertension (PAH). However, specific dosing guidelines for intubated ICU patients are currently lacking.

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Area of Science:

Pharmacology
Pulmonology
Critical Care Medicine

Background:

Prostacyclins-prostanoids represent an early therapeutic class for pulmonary arterial hypertension (PAH).
Key prostanoids developed for PAH include epoprostenol, treprostinil, and iloprost.
Growing clinical experience exists with inhaled formulations of these agents in acute settings.

Purpose of the Study:

To review the current use of inhaled prostanoids in managing pulmonary arterial hypertension (PAH).
To highlight the potential benefits of inhaled prostanoids over intravenous administration regarding ventilation/perfusion matching.
To identify the absence of established guidelines for inhaled prostanoid delivery in intubated intensive care unit (ICU) patients.

Main Methods:

Literature review of studies investigating inhaled prostanoids for PAH.
Analysis of physiological effects of inhaled versus intravenous prostanoid administration.
Examination of current clinical practices and recommendations for PAH management in critical care.

Main Results:

Inhaled prostanoids may enhance ventilation/perfusion matching in PAH patients.
Intravenous prostanoids can lead to nonselective pulmonary vasodilation, potentially impairing ventilation/perfusion matching.
There is a lack of universal recommendations for dosing and delivery of inhaled prostanoids to intubated ICU patients.

Conclusions:

Inhaled prostanoids offer a potential advantage in ventilation/perfusion matching for PAH treatment.
Further research and guideline development are needed for optimal use of inhaled prostanoids in critically ill, intubated PAH patients.
Standardized protocols are essential for the safe and effective administration of inhaled prostanoids in the ICU setting.