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Published on: May 11, 2015
Continuous Prostanoid Initiation in Severe Pulmonary Hypertension in the Pediatric Cardiac Intensive Care Unit
Richard U Garcia1, Asaad Beshish2, Arene Butto2
1Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, 2835 Brandywine Rd, Suite 400, Atlanta, GA, 30341, USA. rugarci@emory.edu.
Insights
Prostanoid (PGI2) use in pediatric cardiac intensive care units is limited. Hypotension was the most common side effect, leading to discontinuation in one-third of patients receiving PGI2 therapy.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Pharmacology
Background:
- Pulmonary hypertension (PH) in critically ill children presents management challenges.
- Limited data exists on prostanoid (PGI2) efficacy and safety in pediatric cardiac intensive care units (CICUs).
Purpose of the Study:
- To evaluate the use, tolerance, and outcomes of continuous prostanoid (PGI2) therapy in critically ill pediatric patients with pulmonary hypertension (PH).
Main Methods:
- Retrospective, single-center study of 24 pediatric patients with PH receiving continuous PGI2 from January 2015 to April 2022.
- Data included demographics, PH etiology, PGI2 type/dose, vasoactive/ventilatory support, and survival.
- Hemodynamic data and adverse events were analyzed.
Main Results:
- PGI2 therapy (epoprostenol, treprostinil) was administered to 24 patients (mean age 3.1 years).
- At initiation, 87.5% received vasoactive infusions, 79.2% mechanical ventilation, and 25% ECMO.
- In-hospital mortality was 37.5%; mechanical ventilation and ECMO were associated with higher mortality risk.
Conclusions:
- Prostanoid (PGI2) therapy was tolerated by approximately 50% of patients, with hypotension being the primary reason for discontinuation in one-third.
- Further research is needed to optimize patient selection, PGI2 type, and dosing in the CICU setting.
Objective:
Limited data exists regarding prostanoid (PGI2) use in critically ill patients with pulmonary hypertension. (PH) in the pediatric cardiac intensive care unit (CICU) setting.
Materials And Methods:
Single center, retrospective study of patients with diagnosis of PH who received continuous PGI2 and were admitted to CICU from January/2015 to April/2022. Data collected included patient demographics and clinical characteristics including diagnosis, etiology of PH, vasoactive and ventilatory support, length of stay, and survival. Type, initial, maximum, and final dose of PGI2 as well as hemodynamic data was obtained. Data reported as mean ± standard deviation. Significance taken p value < 0.05.
Results:
24 patients received PGI2 therapy at a mean age of 3.1 years, range (0-16.6 years). PGI2 was in the form of IV epoprostenol in 12 patients, IV treprostinil in 6, and SQ treprostinil in 6 patients. Mean initial dose was 2.79 ng/kg/min, max dose 18.75 ng/kg/min, and mean duration of therapy was 38.5 days. At PGI2 initiation, 21 (87.5%) were on vasoactive infusions, 19 (79.2%) mechanically ventilated (MV), and 6 (25%) were on extracorporeal membrane oxygenation (ECMO). The in-hospital mortality rate was 37.5% (n = 9). Patients MV and on ECMO support had higher risk of death (p = 0.04, and < 0.01, respectively).
Conclusion:
PGI2 therapy was tolerated in approximately 50% of patients with the most common side effect being hypotension leading to discontinuation in 1/3rd of patients. Ongoing evaluation of the benefits of PGI2 for patients in the CICU setting will help better identify patient selection, type, and dosing of PGI2.
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